papilledema


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Papilledema

 

Definition

Papilledema is a swelling of the optic nerve, at the point where this nerve joins the eye, that is caused by an increase in fluid pressure within the skull (intracranial pressure). Swelling of the optic nerve due to other causes such as infection or inflammatory disease is not called papilledema.

Description

The optic nerve is the nerve that transmits signals from the eye to the brain. Papilledema is a swelling of this nerve where it meets the eye (the optic disc) caused by an increase in intracranial pressure. Almost all cases of papilledema are bilateral (affect both eyes). Papilledema can be observed in people of any age, but is relatively uncommon in infants because the bones of the skull are not fully fused together at this age.

Causes and symptoms

Papilledema is caused by an increase in the pressure of the fluid (cerebrospinal fluid) that is present between the brain and the skull, inside the head. This increase in intracranial pressure may be caused by any of a variety of conditions within the skull, brain, or spinal cord. The most common causes of papilledema are:
  • tumor of the brain, spinal cord, skull, spinal column, or optic nerve
  • abscess (the accumulation of pus within a confined space)
  • craniosynostosis (an abnormal closure of the bones of the skull)
  • hemorrhage (bleeding)
  • hydrocephalus (an accumulation of cerebrospinal fluid within the skull)
  • intracranial infection (any infection within the skull such as meningitis and encephalitis)
  • head injury
The symptoms of papilledema include:
  • headaches, which are usually worse upon awakening and exacerbated by coughing, holding the breath, or other maneuvers that tend to increase intracranial pressure.
  • nausea and vomiting.
  • changes in vision, such as temporary and transient blurring, graying, flickering, or double vision

Diagnosis

A diagnosis of papilledema is achieved by visual examination of the eye with an ophthalmoscope. This instrument shines light through the pupil of the eye and illuminates the retina while the clinician looks through it. Eye drops to dilate the pupils are used to insure a thorough examination.

Treatment

Treatment of papilledema is generally aimed at the treatment of the underlying disorder that is causing papilledema.
Diuretic drugs combined with a weight reduction program may be useful in cases of papilledema that are caused by an abnormally high production of cerebrospinal fluid.
Corticosteroids have been shown to be effective in relieving the symptoms in some patients with papilledema caused by inflammatory disorders.

Alternative treatment

Alternative treatments for conditions that cause the occurrence of papilledema include acupuncture, aromatherapy, hydrotherapy, massage, and herbal remedies.

Prognosis

With prompt medical care to treat the underlying cause of papilledema, a person affected with papilledema will not have permanent damage to his or her eye-sight. However, prolonged papilledema can result in permanent damage to the optic nerve which could lead to blindness.

Prevention

Preventing papilledema is only possible if the underlying condition causing the papilledema can be found. Treatment of this underlying condition may prevent recurrences of papilledema.

Key terms

Craniosynostosis — A premature closure of one or more of the joints (fissures) between the bones of the skull, which causes an abnormally shaped skull.
Hydrocephalus — The accumulation of cerebrospinal fluid within the skull.
Ophthalmoscope — A medical instrument which shines a light through the pupil of the patient's eye and illuminates the retina (back) of the eye, allowing a visual examination of the interior of the eye.

Resources

Books

Rhee, Douglas J., and Mark F. Pyfer. The Wills Eye Manual. 3rd ed. Philadelphia, PA: Lippincott Williams and Wilkins, 1999.

Periodicals

Agarwal, A. K., et al. "Papilledema." Journal of the Indian Academy of Clinical Medicine 1 (October-December 2000): 270-277.

Organizations

National Eye Institute. 2020 Vision Place, Bethesda, MD 20892-3655. (301) 496-5248. http://www.nei.nih.gov/.

Other

Giovannini, Joseph, and Georgia Chrousos. "Papilledema." eMedicine. May 12, 2001. http://www.emedicine.com/OPH/topic187.htm.

disk

 [disk]
a circular or rounded flat plate; often spelled disc in names of anatomic structures.
articular disk a pad of fibrocartilage or dense fibrous tissue present in some synovial joints.
Bowman's disk one of the flat plates making up a striated muscle fiber.
choked disk papilledema.
ciliary disk pars plana.
embryonic disk (germ disk) (germinal disk) a flattened round bilaminar plate of cells in the blastocyst of a mammal, where the first traces of the embryo are seen; called also embryonic or germinal area.
herniated disk see herniated disk.
intervertebral disk the layer of fibrocartilage between the bodies of adjoining vertebrae; see also herniated disk.
intra-articular d's articular disk.
Merkel's d's small cup-shaped tactile receptors in the skin that are particularly sensitive to continuous pressure.
optic disk the intraocular part of the optic nerve formed by fibers converging from the retina and appearing as a pink to white disk in the retina; there are no sensory receptors in the region and hence no response to stimuli. Called also blind spot.
ruptured disk herniated disk.
slipped disk popular term for herniated disk.

pa·pil·le·de·ma

(pap'il-ĕ-dē'mă),
Edema of the optic disc, often due to increased intracranial pressure.
Synonym(s): choked disc
[papilla + edema]

papilledema

 Opthalmology Swelling of the optic nerve and optic disk, indicating ↑ intracranial pressure on the optic nerve, often linked to brain tumors

pa·pil·le·de·ma

(pap'il-ĕ-dē'mă)
Edema of the optic disc, due to increased intracranial pressure.
Synonym(s): choked disc, papilloedema.

pa·pil·le·de·ma

(pap'il-ĕ-dē'mă)
Edema of the optic disc.
Synonym(s): choked disc, papilloedema.
[papilla + edema]
References in periodicals archive ?
Regarding possible individual variability in the evaluation of neuroimaging findings that are related to the increase in ICP and are defined to assist in the diagnosis of IIH without papilledema, MRI and MRV findings
A comparison of idiopathic intracranaial hypertension with and without papilledema. Headache.
Further physical examination exhibited bilateral papilledema together with left-sided hemiparesis and hypoesthesia.
(21-22) Suh (21) also describes two cases where there were conspicuous symptoms of IIH, such as evidence of optic disc swelling (papilledema), yet normal lumbar puncture opening pressures, sella turcica, scleral appearance and venous diameters.
The patient's visual acuity returned to normal, and the papilledema resolved, but the patient was noted to have some residual optic nerve atrophy.
Recognition of progressive enophthalmos and papilledema while being followed up because of the diagnoses of headache and ptosis was important.
Non-parenchymal involvement is observed with the findings of an increase in intracranial pressure that includes severe headache, papilledema and oculomotor nerve palsy.
The result of physical examination (P/E) was papilledema on ophthalmoscopy and right-sided sixth cranial nerve palsy.
He had bilateral papilledema, which was confirmed by two ophthalmologists from separate institutes.
Altered consciousness was accompanied by minor hemiparesis in 6 patients, papilledema in 3, and neck stifness in 6, while 1 patient had myoclonus.