What is papilledema?
Papilledema is an eye condition that happens when pressure in your brain makes your optic nerve swell.
Papilledema can have a number of causes. A mild case of papilledema with symptoms that don’t disrupt your life is nothing to worry about. But papilledema can be a sign of an underlying condition or injury that needs to be treated as soon as possible. This is especially true if you notice the symptoms after major trauma to your head.
The most common early symptoms of papilledema are brief changes to your vision. These changes may barely be noticeable at first, with blurring, double vision, seeing flashes, or vision loss lasting a few seconds. If brain pressure continues, these changes may last for minutes at a time or longer. In some cases, they may become permanent.
The brain swelling that causes papilledema triggers other symptoms that distinguish it from other eye conditions, including:
- feeling nauseous
- throwing up
- having abnormal headaches
- hearing ringing or other noises in your ears (tinnitus)
The fluid bathing your brain and spinal cord is known as cerebrospinal fluid, or CSF. Optic nerve swelling can happen when CSF builds up where your optic nerve and the central retinal vein travel between your brain and your eye nerve. This area is known as the subarachnoid space. When pressure pushes on the nerve and vein, blood and fluid can’t leave the eye at a normal rate, causing papilledema.
Brain swelling can be caused by a number of injuries and conditions, including:
- traumatic injury to your head
- not having enough red blood cells or hemoglobin (anemia)
- CSF buildup in your brain (hydrocephalus)
- brain bleeding (hemorrhage)
- brain inflammation (encephalitis)
- brain tissue inflammation (meningitis)
- high blood pressure (hypertension)
- collection of infected pus in the brain (abscess)
- brain tumor
Sometimes, brain pressure builds up for no apparent reason. This is known as idiopathic intracranial hypertension, which is more likely to happen if you’re obese.
Your doctor may perform a lumbar puncture, also called a spinal tap, to drain extra fluid from your brain and reduce swelling. Your doctor may also prescribe acetazolamide (Diamox) to keep your nervous system pressure at a normal level.
If being overweight or obese is causing papilledema, your doctor may recommend a weight loss plan as well as a diuretic, which may help reduce the pressure inside of your head.
Your doctor may prescribe medications to reduce swelling. Corticosteroids, such as prednisone (Deltasone), dexamethasone (Ozurdex), and hydrocortisone (Cortef), can all be used to keep swelling down in your brain. These medications may be injected or taken by mouth.
If high blood pressure is causing papilledema, your doctor may prescribe medications to keep your blood pressure under control. Common medications for high blood pressure include:
- Diuretics: bumetanide (Bumex) and chlorothiazide (Diuril)
- Beta blockers: atenolol (Tenormin) and esmilol (Brevibloc)
- ACE inhibitors: captopril and moexipril
If you have a brain tumor, your doctor may recommend surgery to remove part or all of the tumor, especially if the tumor is cancerous. Radiation or chemotherapy may also help make the tumor smaller and reduce swelling.
If an infection is causing your papilledema, your doctor may prescribe antibiotics. Infection medications differ based on what type of bacteria is causing the infection. If you have an abscess, your doctor may use a combination of antibiotics and drainage to treat a possible infection as well as to remove the infected pus or fluid from your brain.
If you’ve just had a major head injury, your doctor will try to reduce pressure and swelling in your head. This may involve draining CSF from your head and removing a small piece of your skull to relieve the pressure.
Your doctor will first do a full physical examination to check your overall health and look for any other symptoms. Your doctor will likely test your field of vision by moving their hands back and forth past your eyes to see where your blind spots are.
Your doctor may also use a tool called an ophthalmoscope to look in each of your eyes at your optic nerve through your pupil, the opening in the front of your eye. Your doctor may diagnose you with papilledema if your optic disc, which is at the end of the optic nerve, looks abnormally blurry or high up. Your doctor might also see spots of blood in your eye if you have this condition.
If your doctor believes a brain condition is causing papilledema, they’ll do additional tests. Your doctor may order an MRI test or a CT scan of your head to check for tumors or other abnormalities in your brain and skull. Your doctor may take a tissue sample (biopsy) of the tumor to test for cancerous cells or drain some of your CSF to test it for any abnormalities.
Papilledema can cause blindness if the pressure continues for a long time without being treated, even if there isn’t an underlying condition.
Other complications of untreated papilledema related to the conditions that can cause it include:
- brain damage
- constant headaches
Papilledema isn’t usually an issue on its own. It can typically be treated by draining extra CSF fluid, which reduces swelling. Symptoms then disappear in a few weeks.
Swelling or injury to your brain can be serious and life-threatening. If papilledema is caused by an underlying condition, get treated right away to prevent any long-term complications.