Papilledema occurs when there is a buildup of pressure in or around the brain, which causes the optic nerve to swell. It is critical to identify the cause of papilledema, which can be life-threatening. It can occur in one or both eyes.
This article will outline what papilledema is, as well as its symptoms and how it can be treated.
What are the causes?
There are many potential causes for papilledema, and some of them may not be obvious.
The optic nerve is a bundle of fibers that transmits visual information between the retina and the brain. The area where the optic nerve enters the back of the eyeball is known as the optic disc.
The brain and optic nerve are surrounded by cerebrospinal fluid (CSF), which helps to keep them stable and protected from damage from sudden movements.
Papilledema occurs when increased pressure from the brain and cerebrospinal fluid is placed on the optic nerve.
This causes the nerve to swell as it enters the eyeball at the optic disc.
There are some serious medical conditions that can cause this increased pressure to develop, including:
- head trauma
- inflammation of the brain or surrounding tissue
- severely high blood pressure, known as a hypertensive crisis
- infection in the brain
- brain tumor
- bleeding in the brain
- blockages of blood or cerebrospinal fluid in the brain
- abnormalities of the skull
Idiopathic intracranial hypertension (IIH) describes a rare condition where the body produces too much cerebrospinal fluid. This leads to increased pressure in the brain.
Symptoms of IIH usually include headaches, visual disturbances, and ringing in the ears.
The exact cause of this condition is unknown and is not related to any brain disease or injury.
IIH often affects younger, obese females. It can also be associated with medications, such as lithium, certain antibiotics, thyroid hormone treatment, and corticosteroids.
Surgery is usually only recommended if lifestyle changes or medication do not help.
Treatment of papilledema will vary and depend on the cause.
When caused by IIH
In the case of IIH, common treatments include weight loss, a low-salt diet, and medications, such as acetazolamide, furosemide, or topiramate.
Surgery is usually only considered when lifestyle changes and medications have not helped.
When caused by tumors, head injury, or infection
Certain underlying conditions will require more serious treatment. For example, a brain tumor, bleeding within the brain, a blood clot, or some other brain conditions often require surgery
The types of surgical procedures used depend on the conditions they need to rectify.
Infections, on the other hand, are usually treated with antibiotics or antiviral medications.
When caused by high blood pressure
In rare cases, papilledema can be caused by extremely high blood pressure, for example, greater than 180/120.
When a person’s blood pressure is this high, it is known as a hypertensive crisis and requires emergency medical care. In these cases, blood pressure must be lowered to avoid more serious harm. This will mean medical treatment in the emergency room and intensive care unit.
Treatment for other causes
There are a wide variety of other medical problems and conditions that can lead to increased pressure inside the brain.
Brain and eye specialists can help determine the best treatment options based on the condition that is diagnosed.
What are the symptoms?
Since an increase in pressure inside the brain is the cause of papilledema, the symptoms can include:
- visual disturbances, including double vision
- a ringing sound in the ears, often pulse-like
A doctor or optician may diagnose papilledema by using an ophthalmoscope, to inspect the eye.
Initially, a doctor who suspects a person may have papilledema will do a complete physical examination of the eyes and nervous system.
Diagnosis typically involves a tool called an ophthalmoscope, an instrument resembling a pen with a lighted wheel at the tip.
The ophthalmoscope is used to inspect the back portion of the eye through the pupil. This may require a dilated eye where drops are placed in the eye to force the pupil to become larger.
A doctor will assess the optic disc for any abnormalities, such as it having been pushed out of position or appearing more blurred than normal. These changes can indicate that the optic nerve is swollen.
In more severe cases, spots of blood may appear on the retina. Tests can also be done to assess any changes in color vision, losses of vision, or double vision, along with visual accuracy assessments.
If signs of papilledema are detected, brain-imaging scans will be needed. These can include magnetic resonance imaging (MRI) or computed tomography (CT).
Blood tests and a lumbar puncture or test that takes a sample of cerebrospinal fluid from the spinal canal may also be necessary.
In all instances, it is vital to determine the reasons for an increase in pressure that affects the brain.
Papilledema is a sign that the brain is under increased pressure, which is never normal. Uncovering the cause of this change in pressure is a necessary step towards treatment of papilledema.
Proper diagnosis and treatment will require a variety of tests, along with the input of eye and brain specialists, to determine how best to manage the condition.
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