What is papilledema?
Papilledema is a swelling of the optic nerve that connects the eye and the brain. This swelling is a reaction to increased stress in or around your brain.
It’s a warning sign of a serious medical condition that needs attention, such as a brain tumour or haemorrhage. But sometimes the pressure and swelling can’t be traced to a specific problem. In that case, there are other ways to ease the swelling. If left untreated, papilledema leads to loss of vision.
Causes of papilledema
Your brain’s network of nerves, blood, and fluid all fit snugly inside your skull. Because there’s a limited amount of space when tissues swell, something grows, or there’s more liquid than normal, the pressure inside goes up and, in turn, can cause papilledema. That may happen because of:
- Head injury
- Brain or spinal cord tumour
- Bleeding in the brain
- Blood clots or a problem in some veins.
- Brain tumour
Meningitis or encephalitis
Infection of the meninges that protects the brain (encephalitis) or the brain (meningitis) causes inflammation, resulting in swelling or fluid pressure leading to papilledema.
If you have a head injury, you may experience bleeding, bruising, or swelling from the injured areas of your brain. Usually, a head injury does not cause papilledema, but if the injury is near the eyes or if the swelling is severe throughout the brain.
The following factors are associated with pseudotumor cerebellum:
- Postpartum women are more likely to have this disorder
- Ingredients associated with secondary intracranial hypertension
- Growth hormone
- The high content of vitamin A
- Health problems
Conditions and diseases associated with secondary intracranial hypertension:
- Addison’s disease
- Blood clotting disorders
- Polycystic ovary syndrome
- Sleep apnea
- Useless parathyroid glands
Symptoms of papilledema
Since an improvement 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
Blurred vision or vision loss: This is caused by physical stress on the optic nerves that control your vision. Some people with optic nerve compression lose blurred vision or vision in one or both eyes. Unlike many other neurological conditions that lose symmetrical vision in both eyes, papilledema is associated with loss of vision in one eye. or asymmetry in both eyes.
Headache: Papilledema is often associated with headache and pressure in the head because conditions that cause inflammation of the optic nerve can also cause pressure and pain within the skull. Although each person with papilledema has a different head position associated with comfort or pain, your pain will intensify and improve as your head position changes.
Pain behind one or both eyes: The increased pressure caused by papilledema may be more concentrated near one or both eyes, making it more severe behind the eyes than on the head.
Diagnosis of papilledema
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 colour 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.
Treatment for papilledema
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 tumours, head injury, or infection
Certain underlying conditions will require more serious treatment. For example, a brain tumour, 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.
Departments to consult for this condition
- Department of Ophthalmology