Is bilateral papilledema a serious one?

Patient's Query

Hi doctor,

My wife was recently seen by an ophthalmologist for loss of peripheral vision in one eye and a feeling of something wrong with her eye, as though it were closed. Ophthalmologist diagnosed it as bilateral papilledema and referred to neurologist for immediate follow up. The ophthalmologist insisted the follow up and MRI to be taken immediately. However, at neurologist my wife nervously downplayed symptoms and the doctor, who is overbooked, has her next appointment in two months and the MRI tentatively in four weeks out. Should we seek another doctor? We are concerned that this should be handled more rapidly based on the ophthalmologist reaction.

Answered by Dr. Vaibhev Mittal

Hi,

Welcome to icliniq.com. Please do not get panic.

Papilledema is swelling of optic nerve head due to increase in intracranial pressure. This pressure may be high due to some tumor or blockage of sinuses or idiopathic (without cause).

The investigations required are:

Perimetry should be done by ophthalmologist along with recording visual acuity, color vision and contrast sensitivity.
MRI - To rule out any intraocular mass.
MRV (magnetic resonance venography) - To rule out sinus blockage.

This is common in young females and even more common if patient is taking oral contraceptive pills.

If all these are fine then CSF - cerebrospinal fluid opening pressure is recorded along with CSF cytology.

In papilledema, due to idiopathic cause (known as IIH) treatment would aim to decrease pressure by oral tablets of Acetazolamide.

Regarding your question, I would suggest you to tell me the visual acuity and reports of perimetry. If these are impaired then you should at least go for MRI and MRV urgently as these investigations will rule out any life threatening condition.

If papilledema is due to IIH (idiopathic intracranial hypertension) then IIH is benign in 90 % of the cases.

Revert back with the perimetry reports to an eye care ophthalmologist online --> https://www.icliniq.com/ask-a-doctor-online/eye-care-ophthalmologist

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Q. Is bilateral papilledema a serious one?

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