Papilledema - Causes, Symptoms, Diagnosis, and Treatment

What Is Papilledema of the Eye?

Papilledema is a serious condition of the eye. In this condition, the swelling of the optic disc takes place. This is caused due to increase in intracranial pressure. It may develop suddenly, or it may develop over a period of time. A medical professional should be consulted at the earliest as it may denote any serious underlying medical condition, such as a brain tumor, any inflammation of the central nervous system, and an increase in intracranial pressure due to unknown causes.

Papilledema cannot exist without an increase in intracranial pressure. Hence, it is always secondary to the rise in intracranial pressure. It can occur in both eyes simultaneously.

What Are the Symptoms of Papilledema?

Papilledema occurs following the increase in intracranial pressure. It may occur for a few seconds or may even be present throughout. The following may be the symptoms of papilledema:

Initial symptoms:

1. Blurring of Vision: The pupils may become small, leading to blurred vision. This condition may also lead to a decrease in color perception.

2. Diplopia: The person may experience double vision due to the swelling of the optic disc.

3. Flashes: This condition may cause a transient visual disturbance that can look like flashes or flickering.

4. Loss of Vision: The person may experience vision loss due to swelling of the optic nerve and the optic disc.

If the pressure in the brain increases or remains constant, it may be associated with other symptoms such as :

1. Headache: This condition may be accompanied by a sudden headache that indicates an increase in intracranial pressure. The headache may be of a very serious nature. It may worsen on awakening and movements.

2. Nausea and Vomiting: An increase in intracranial pressure can lead to severe nausea and vomiting. This may eventually lead to loss of consciousness and death.

3. Tinnitus: The person may experience a ringing sensation in the ear.

What Are the Causes of Papilledema?

Papilledema mainly occurs when the optic nerve experiences pressure from the brain. This pressure could be exerted due to various reasons, such as tumors or any space-occupying lesions of the brain. This pressure on the optic nerve causes it to expand, leading to enlarged disc space or papilledema. The various causes of papilledema are:

1. Tumors: Tumors of the brain can cause an increase in intracranial pressure as it is a space-occupying lesion. To compensate for the space demand, pressure inside the cranium increases, leading to papilledema.

2. Intracranial Hypertension: Intracranial hypertension of unknown origin or idiopathic intracranial hypertension is one of the most common causes of papilledema. This form of hypertension leads to an increase in intracranial pressure leading to an increase in the disc space.

3. Change in the Volume of Cerebrospinal Fluid (CSF): An increase or decrease in the volume of CSF can alter intracranial pressure. This fluctuation in the volume can be due to various factors such as a tumor, injury, or infection. This change in volume can ultimately lead to increased pressure in the disc space.

4. Obstruction: Any obstruction in the vessels that supply the brain can cause increased intracranial pressure. This can ultimately result in papilledema.

5. Encephalitis: A rise in intracranial pressure can be due to edema in the cranial cavity that may be caused due to various factors.

6. Craniosynostosis: This is a condition wherein the skull or the cranium is smaller in size when compared to the brain. This mismatch in the size and shape of the brain and the skull can cause increased intracranial pressure that ultimately leads to papilledema.

7. Medications: Certain medications such as Tetracycline, Minocycline, Doxycycline, lithium, antibiotics, and corticosteroids can cause papilledema.

8. Head Injury: Any injury to the head can cause an increase in intracranial pressure. An injury to the head may also be associated with intracranial hemorrhage. This together causes intracranial pressure to increase, ultimately leading to papilledema.

9. Blockage of CSF: Any blockage in the pathway of CSF can occur that can increase intracranial pressure.

10. Hypervitaminosis-A: An increase in intracranial pressure can be caused by an excess of vitamin A.

11. Obesity: Obesity can act as an important causative factor for an increase in intracranial hypertension, which can ultimately result in papilledema.

12. Guillain-Barre Syndrome: It is an autoimmune disorder of the nervous system which has a sudden onset. This causes an increase in intracranial pressure and, ultimately, papilledema.

What Are the Complications of Papilledema?

Papilledema can lead to various complications, such as:

1. Papilledema, if left untreated, can lead to total blindness.

2. Brain damage.

3. Stroke.

4. Seizures.

5. Severe recurring headache.

How to Diagnose Papilledema?

1. Physical examination of the eye can be done using an ophthalmoscope. This aids in studying the optic disc and optic nerve. The initial physical examination can aid in the detection of papilledema.

2. If physical examination denotes papilledema, the doctor may advise investigations such as an MRI (magnetic resonance imaging) or CT (computed tomography) scan to find the underlying causative factor.

3. Sometimes a blood or CSF investigation may also be needed.

How to Treat Papilledema?

Treatment of papilledema depends on the causative factor. Resolution of the causative factor can cause the papilledema to resolve.

1. In case of an increase in intracranial pressure due to a change in the CSF volume, the extra volume may be drained to decrease the intracranial pressure.

2. If papilledema occurs due to hypertension, medications and diet may be prescribed to reduce intracranial pressure.

3. If obesity is the causative factor, the doctor may ask the patient to lose weight through exercise and diet or through surgical means like bariatric surgery.

4. If the intracranial pressure increases due to pathologies like tumors, after necessary diagnostic procedures, appropriate treatment can be given. This may include surgery and other treatments like chemotherapy and radiotherapy.

5. In the case of papilledema due to head injury, this condition can be resolved after following the necessary protocols and treatments.

Conclusion:

Papilledema is not a condition of its own; it is an outcome of the underlying causative factors. Upon resolution of these underlying conditions or pathologies, papilledema can be cured. However, this condition is not to be taken lightly, and immediate medical care should be taken for early resolution and to prevent complications.