Is bilateral papilledema a serious one?

Question

Hi doctor,

My wife was recently seen by an ophthalmologist for loss of peripheral vision in one eye and a feeling that something was wrong with her eye, as though it were closed. An ophthalmologist diagnosed it as bilateral papilledema and referred to a neurologist for immediate follow-up. The ophthalmologist insisted that the follow-up and MRI be taken immediately. However, at the 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's reaction. Kindly help.

Answer 1

Hi,

Welcome to icliniq.com.

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

The investigations required are:

Perimetry should be done by an 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 the 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 an idiopathic cause (known as IIH), treatment would aim to decrease pressure by oral tablets of Acetazolamide.

Regarding your question, I would suggest that you tell me the visual acuity and reports of perimetry. If these are impaired, then you should at least go for an MRI and an MRA 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 cases. Revert with the perimetry reports.

I hope I have addressed your concerns. Feel free to reach out if you have any further questions.

Thank you.