Papilledema is the medical term denoting swelling of optic disc. It can develop due to intracranial pressure, infections, or inflammation developed on the optical disc. One should not confuse papilledema with disc atrophy (that occurs due to loss of nerve fiber on the optical nerve). This condition can produce symptoms like headache, nausea and vomiting also apart from affecting the normal vision. Papilledema can cause blurred vision or flickering vision.
The prominent symptom of papilledema is optical swelling due to intracranial pressure. In addition, it can cause headache (more when the person wakes up in the morning), nausea and vomiting and rarely loss of consciousness. Some people would have blurred vision, flickering vision and decreased perception of color due to this problem. In some cases diplopia is seen if the sixth nerve palsy is affected.
The symptoms are not found in all the cases. For many people papilledema is found only on routine eye examination. Some of the early signs of papilledema are disc hyperemia, swelling of nerve fiber layer, and small hemorrhages in the nerve fiber layer. Spontaneous pulsation will be missing in many individuals if the intracranial pressure is above 200mm of water. As the disease continues to progress, it can cause swelling of nerve fiber layer with venous congestion.
Papilledema develops due to intracranial pressure on the optical disc. Presence of any tumor or lesions on the CNS and cerebral edema can cause this problem. Infectious diseases like meningitis, venous sinus thrombosis and hemorrhage in subarachnoid membrane can cause papilledema. Intake of strong medications like tetracycline, lithium, and corticosteroids can also cause this problem.
Neuroimaging tests are highly effective in detecting papilledema. The degree of swelling of optical disc will be assessed using several ophthalmologic tests. Optical coherence tomography will be done to keep track of the changes in the optical disc. If papilledema occurs due to other causes like ischemic optical neuropathy or optic neuritis or retinal vein occlusion then complete ophthalmologic evaluation is to be done. MRI scan will be done to rule out any other clinical causes like venous sinus thrombosis or lesions on the central nervous system.
Some experts use staging system to categorize papilledema.
Early Stage : In this stage, the retinal veins will be distended and disc capillaries will be dilated.
Acute Stage : There will be internal hemorrhage looking like small red spots inside. In addition the retinal vessels will be hidden due to swelling.
Chronic Stage : Papilledema will be progressing gradually without any acute signs. In the later stage the optical disc will become pale with prominent swelling.
The aim of treatment to papilledema is to reduce the intracranial pressure and inflammation developed on the optical disc. Depending on the intensity of the disorder and the urgency of underlying medical condition, either medical therapy or surgical procedure is initiated. Several factors like age, health condition of the patient is considered before proceeding for surgery. Diuretic drugs like acetazolamide or anhydrase inhibitor medications are prescribed to reduce intracranial pressure in case the underlying cause of papilledema is not known.
For optical disc swelling due to venous sinus thrombosis hematologist is to be consulted. In case the individual has developed intracranial pressure due to increased weight then the doctor may consider bariatric surgery for weight reduction. In most of the cases other weight loss methods like restricted diet and exercise are recommended. For people who have developed inflammatory disorders corticosteroids like prednisone are prescribed in low doses.
Surgery is the last option for papilledema when no other therapeutic methods are effective. Tumors or mass lesions on the eyes are removed surgically. For people with intracranial hypertension lumboperitoneal shunt is provided by surgery. In case no other treatments can improve the ocular symptoms optical nerve sheath decompression surgery is to be done. In most of the surgical cases the patient should also consult a neurologist in addition to an ophthalmologist.