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 eyesight. 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.

BOOKS

Rhee, Douglas J., and Mark F. Pyfer. The Wills Eye Manual, Third Edition. 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. <http://www.emedicine.com/OPH/topic187.htm>. (12 May 2001).

Paul A. Johnson

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 that 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.