Papilledema

What you need to know about Papilledema

Papilledema (or papilloedema) is a condition where the optic nerve that connects your eye to your brain swells because of pressure building in or around your brain.

Papilledema can be a warning sign of a serious underlying health problem often requiring urgent medical attention. It can also cause permanent vision loss if not treated so it’s always best to seek medical treatment immediately if you think you may be suffering from papilledema.

Treatment usually involves tackling the cause of the increased pressure in your brain. In cases where the swelling can’t be traced back to a particular problem, treatment will focus on reducing pressure in your brain.

Optic Neuritis is another, distinct condition that also involves swelling of the optic nerve. Optic neuritis has different causes, symptoms and treatment options than papilledema.

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Papilledema Causes

The optic nerve is the cable that transmits information from the nerves in your eyes to the part of your brain that interprets these signals as images. To keep your brain and optic nerves stable, they are surrounded by a substance called cerebrospinal fluid (CSF). If there is increased pressure in the brain and CSF, this causes a swollen optic nerve. The pressure can cause long-term damage to your optic nerve which can cause permanent vision loss.

Papilledema Symptoms

Papilledema usually occurs in both eyes at the same time. Occasionally it only affects one side.

You may have papilledema for a while before you notice any symptoms. The first noticeable papilloedema symptoms usually affect the vision as the swelling behind the eye puts pressure on the optic nerve. This can include short episodes of blurred or double vision, flickering lights, or blacked out vision. Increased pressure in the brain may also cause a combination of headaches, nausea, and vomiting.

If IIH is the cause of papilledema, you are likely to experience headaches that get worse over time, vision problems and throbbing or ringing in the ears.

Papilledema Diagnosis

The optometrist will use an ophthalmoscope (a slit lamp with a condensing lens) to look at the back of your eye to detect the condition. We will look at the structure of the eye to find out the seriousness and progression of your condition using a scale which consists of five papilledema stages.³ They may also use retinal photography and an OCT (optical coherence tomography) scan. If detected, you will be referred to an ophthalmologist.

In addition, the ophthalmologist may also use MRI or CT scans to both diagnose causes and monitor the success of treatments. A spinal tap (lumbar puncture) can also be used to check for any infections or evidence of a tumour, and to check the pressure of the cerebrospinal fluid.

Sometimes they might use ultrasonography (using sound waves to produce an image of the eye) to check whether the swelling is due to papilledema or another condition.

Papilledema Treatment

Papilledema must be treated as soon as possible to avoid permanent vision loss. The treatment will depend on the cause. Effective treatment of the underlying cause should also cure the papilledema.

In the case of a tumour, medication may help but surgery or radiation therapy may also be required.
A head injury may require surgical treatment.
Infections may be treated with antibiotic or antiviral medication.
A brain abscess will need to be drained followed by a course of antibiotics.
Extremely high blood pressure (known as a hypertensive crisis) will need emergency medical treatment.
If medication is the cause, your doctor may prescribe an alternative.
Spinal taps might be prescribed to remove spinal fluid and reduce pressure in the brain.
IID usually responds well to weight loss and a diuretic to reduce fluid pressure. If this proves to be unsuccessful, surgery can be an alternative option.

If you want to learn more about papilledema and where you can get it treated near you, visit the NHS website for further information.

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