What is Papilledema?
Papilledema is a pathological condition of the eye in which there is swelling of the optic nerves within the eye as a result of increased pressure in and around the brain. There may be numerous reasons for an individual to have increased pressure around the brain ranging from a head injury in a motor vehicle crash to uncontrolled severe hypertension.
In the beginning stages of Papilledema, the affected individual may experience no symptoms apart from fleeting loss or disturbance of vision which then gradually progresses to complete loss of vision in some cases in addition to persistent nausea and vomiting.
An individual with fleeting loss of vision that lasts for seconds which gets more and more frequent needs to consult an ophthalmologist at the earliest so as to prevent any serious complications from Papilledema. The ophthalmologist may use an ophthalmoscope to confirm the diagnosis of Papilledema.
What Causes Papilledema?
As stated, Papilledema is mainly caused due to increased pressure in and around the brain. There may be numerous reasons as to why there may be increased pressure within the brain. These causes can be as serious as a brain tumor to a head injury in a motor vehicle crash or being hit by a ball on the head. Internal bleeding in the brain may also cause increased pressure in and around the brain resulting in Papilledema.
Encephalitis which is a medical condition in which there is inflammation of the brain is yet another cause for increased pressure in and around the brain causing Papilledema. Uncontrolled severe hypertension is yet another cause for increased pressure around the brain which results in Papilledema. Normally, these conditions cause both eyes to develop Papilledema.
What are the Symptoms of Papilledema?
In the beginning stages, Papilledema may not cause any symptoms but as the disease progresses and the swelling of the optic nerve increases the affected individual may start to experience vision changes which may come and go and last for a few seconds. The individual may also experience blurred and double vision. In some cases of Papilledema, an individual may suffer from complete loss of vision for a few moments.
Additionally, the individual may also experience persistent headaches as a result of increased pressure in the brain along with nausea and vomiting. It should be noted here that Papilledema does not cause any pain in or around the eye region and hence the diagnosis of Papilledema is at times difficult.
How is Papilledema Diagnosed?
When an individual presents with the above mentioned symptoms to an ophthalmologist, a history will be taken by the physician after which an ophthalmoscope will be used to take a closer look at the eye and the surrounding structures. This may reveal swelling of the optic nerve which is the classic presentation for Papilledema.
Once Papilledema is suspected, then further investigations are done in order to confirm the diagnosis and also determine the cause of increased pressure in and around the brain resulting in Papilledema. This may be done through advanced radiological studies like CT and MRI scan of the brain. A lumbar puncture may be then performed to measure the pressure of the CSF or the cerebrospinal fluid which will be increased in case of increased pressure around the brain.
This CSF fluid may then be sent for analysis to identify the cause of the increased pressure which may be a tumor or an infection. An ultrasound of the eye may also be done to distinguish between Papilledema and other disorders of the eye presenting with similar features. The results of all of the above tests virtually confirm the diagnosis of Papilledema.
How is Papilledema Treated?
The treatment of Papilledema is basically done by treating the cause of it. Since Papilledema is caused due to increased pressure around the brain, thus this becomes a condition which requires immediate medical attention. Once the cause of the increased pressure around the brain is identified then a treatment plan is formulated.
If brain tumor is responsible for increased pressure around the brain resulting in Papilledema, then resection of the tumor becomes necessary to reduce the pressure around the brain and thus treat Papilledema. This may be followed by radiation and if the tumor is malignant then chemotherapy may be done following the resection.
If intracranial hypertension is the cause of increased pressure around the brain causing Papilledema then it can be treated with administration of diuretics. In some cases, surgery may also be done for intracranial hypertension to reduce the pressure on the brain and thus treat Papilledema.
Increased pressure within the brain caused by bacterial or viral infections can be treated with antibiotics and anti-virals respectively in order to successfully treat Papilledema.
Increased pressure in the brain resulting in Papilledema caused due to a brain abscess can be successfully treated by draining the abscess resulting in treatment of Papilledema.
- American Academy of Ophthalmology. Papilledema: Swelling in the Optic Nerve. https://www.aao.org/eye-health/diseases/papilledema-swelling
- British Journal of Ophthalmology. Papilloedema – a review. https://bjo.bmj.com/content/94/12/1629