A RARE EYE DISEASE: PAPILLEDEMA
A RARE EYE DISEASE: PAPILLEDEMA
Papilledema or papilloedema is optic disc swelling that is caused by increased intracranial pressure due to any cause. The swelling is usually bilateral and can occur over a period of hours to weeks. Unilateral presentation is extremely rare. Often, it's a warning sign of a serious medical condition that needs attention, such as a brain tumor 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.
The main reasons for this disease may be a head injury, a brain or spinal cord tumor, Inflammation of the brain or any of its coverings, such as meningitis, Extremely high blood pressure, Bleeding in the brain, a blood clot or a problem within certain veins, Pus collecting from a brain infection and Problems with the flow or amount of fluid that runs through the brain and spinal cord.
Signs and Symptoms
The signs of papilledema that are seen using an ophthalmoscope include: venous engorgement (usually the first signs), loss of venous pulsation, haemorrhages over and/or adjacent to the optic disc, blurring of optic margins, elevation of the optic disc, and Paton's lines (radial retinal lines cascading from the optic disc).
Mechanism and pattern of visual loss
The main mechanism of visual loss is likely due to axoplasmic flow stasis. High ICP produces a rise in CSF pressure surrounding the optic nerves, which disturbs the normal gradient between intraocular pressure and retrolaminar pressure, leading to high tissue pressure within the nerves. The increased tissue pressure within the nerves interrupts the metabolic processes that mediate axoplasmic flow.
Checking the eyes for signs of papilledema should be carried out whenever there is a clinical suspicion of raised intracranial pressure, and is recommended in newly onset headaches. This may be done by ophthalmoscopy or fundus photography, and possibly slit lamp examination. It is important to determine whether the observed condition is due to optic nerve head drusen, which can cause an elevation of the optic nerve head that can be mistaken for papilledema. For this reason, optic nerve head drusen is also called pseudopapilledema.
The treatment depends largely on the underlying cause. However, the root cause of papilledema is the increased intracranial pressure (ICP). This is a dangerous sign, indicative of a brain tumor, CNS inflammation or idiopathic intracranial hypertension (IIH) that may become manifest in the near future.
Thus, a biopsy is routinely performed prior to the treatment in the initial stages of papilledema to detect whether a brain tumor is present. If detected, laser treatment, radiation and surgeries can be used to treat the tumor.To decrease ICP, medications can be administered by increasing the absorption of cerebrospinal fluid (CSF), or decreasing its production. Such medicines include diuretics like acetazolamide and furosemide. These diuretics, along with surgical interventions, can also treat IIH. In IIH, weight loss (even a loss of 10-15%) can lead to normalization of ICP.
In the acute stage, papilledema leads to enlargement of the blind spot, which is the most common and often the only visual field change. With protracted and severe papilledema, nerve fiber layer visual field defects occur. The typical visual field defects found in papilledema are related to nerve fiber bundle damage at the level of the optic disk. The papillomacular bundle and thus central visual acuity appears spared until later stages of the disease. If you don't treat it, papilledema can lead to vision loss.
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The Ophthalmologist: Clinical and Therapeutic Journal