Papilledema

Papilledema is a condition in which increased pressure in or around the brain causes the optic nerve to swell where it enters the eye.

The condition is usually caused by a brain tumor or abscess, head injury, bleeding in the brain, infection of the brain or its tissue coverings (meninges), pseudotumor cerebri (which is not a tumor and is also called benign intracranial hypertension (see Section 6, Chapter 88), or severe high blood pressure. Severe lung disease can also increase pressure in the brain, leading to papilledema. These conditions typically result in papilledema in both eyes.

At first, papilledema may be present without affecting vision. Fleeting visual changes--blurred vision or complete loss of vision--typically lasting seconds are characteristic of papilledema. They may occur when arising from sitting or lying down. Other symptoms may occur due to the elevated pressure in the brain rather than the effects on the eye. Headache may occur.

An ophthalmologist uses an ophthalmoscope to diagnose papilledema. Computed tomography (CT) and magnetic resonance imaging (MRI) may be used to monitor papilledema and help determine its cause. A spinal tap is performed to measure the pressure of the cerebrospinal fluid. A sample of the cerebrospinal fluid may be examined for evidence of a brain tumor or infection.

If the high pressure of the cerebrospinal fluid is due to a brain tumor, corticosteroids are usually given, but surgery to remove the tumor may be needed. Papilledema that occurs as a result of pseudotumor cerebri can be treated with weight loss and a diuretic. Other treatments of papilledema depend on the cause. For example, a brain abscess is drained and antibiotics are given, high blood pressure is lowered with drug therapy (see Section 3, Chapter 22), and an infection, if bacterial, can be treated with antibiotics. If headaches persist, surgery may be needed.