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Papilledema is a condition in which increased pressure in or around the brain causes the optic nerve to swell where it enters the eye.
Causes
The condition is usually caused by the following:
These conditions typically result in papilledema in both eyes.
Symptoms
At first, papilledema may be present without affecting vision. Fleeting vision changes—blurred vision, double vision, flickering, or complete loss of vision—typically lasting seconds are characteristic of papilledema. Other symptoms may be caused by the elevated pressure in the brain. Headache, nausea, vomiting, or a combination may occur.
Diagnosis
An ophthalmologist (a medical doctor who specializes in diagnosing and treating eye disorders) uses an ophthalmoscope to diagnose papilledema. Magnetic resonance imaging (MRI) or computed tomography (CT) may be used to help determine the cause and monitor the effect of treatment. A spinal tap is often done to measure the pressure of the cerebrospinal fluid. A sample of the cerebrospinal fluid may be examined for evidence of a brain tumor or infection. Sometimes an ultrasound of the eye is done to distinguish between papilledema and other disorders that cause apparent swelling of the optic nerve.
Treatment
The disorder causing increased brain pressure is treated as soon as possible. For example, if the high pressure of the cerebrospinal fluid is caused by a brain tumor, corticosteroids may be given, but surgery to remove the tumor may be needed. Papilledema that occurs as a result of idiopathic intracranial hypertension can be treated with weight loss and a diuretic. An infection, if bacterial, can be treated with antibiotics. A brain abscess is drained, and antibiotics are given.
Last full review/revision July 2008 by James Garrity, MD
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