Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Papilledema is swelling of one or both optic nerve discs. The optic nerve disc, also called optic nerve head, is a small oval-shaped area on the back of the eye, marking the site of entrance of the optic nerve into the eyeball.
Papilledema is a sign of some diseases that affect the brain. The conditions that cause papilledema can cause serious damage to the optic nerve or the brain, resulting in vision loss or brain damage if not treated. It can be detected during a routine eye examination with an optometrist, ophthalmologist, or neurologist.
This article covers the symptoms and causes of papilledema. It also discusses how it’s diagnosed and what options are available for treatment.
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Papilledema Symptoms
Papilledema itself is not a disease, but it is a sign of disease. The conditions that cause papilledema may cause some symptoms, particularly if there is a lot of swelling in your optic discs.
Symptoms associated with papilledema can include:
What Causes Papilledema?
Conditions that can cause papilledema include:
Brain Tumor
Brain tumorscan develop in different areas of the brain, causing physical compression or obstruction of CSF flow within the skull. Physical pressure or CSF pressure can cause the optic disc to swell or to appear swollen.
Meningitis or Encephalitis
An infection of the brain (encephalitis) or the meninges that protect the brain (meningitis) can cause inflammation, resulting in swelling or fluid pressure that produces papilledema.
Head Trauma
If you have ahead injury, you may experience bleeding, bruising, or swelling of the injured areas of your brain. Generally, head trauma does not cause papilledema, but it can if the injury is near the eyes or if the swelling throughout your brain is severe.
Bleeding in the Brain
A brain hemorrhage is a bleed in the brain, and it can occur if a blood vessel bursts or due to trauma or astroke. Often, brain hemorrhages result in swelling or excessive blood within the skull that can manifest with papilledema.
What to Know About Subdural Hemorrhages
Idiopathic Intracranial Hypertension/Pseudotumor Cerebri
Pseudotumor cerebriis given that name because the papilledema may be similar to symptoms when someone has a brain tumor, but it occurs without a tumor or a mass in the brain.
This condition can cause permanent vision loss due to persistent pressure on the optic nerves. The fluid needs to be removed, usually with a lumbar puncture, which is also known as a spinal tap.
Cerebral Edema
Swelling and inflammation in the brain can occur due to a variety of causes, such as a largeischemic stroke, lack of oxygen to the brain, multi-organ failure, and fluid imbalance. Edema can also occur as the body’s response to excessive brain damage after a large stroke or when the fluid and electrolytes in the body are not at the proper concentration. Papilledema may worsen or improve depending on the degree of the brain swelling.
What Is POEMS Syndrome?
Diagnosing Papilledema
These diagnostic devices can visualize the inside of your eye behind your pupil. This is not an imaging test; it is a “live” test, meaning that your healthcare provider looks at your eye to evaluate it in person. However, some types of specialized equipment can also take a photo of your eye so that your practitioner can share the results to consult with your other healthcare providers or compare changes in your eye over time.
The appearance of the swelling makes your optic nerve disc look as if it is squished or enlarged, and sometimes there may be distended (abnormally widened), irregularly shaped blood vessels, or cloudy fluid as well.
Once papilledema is diagnosed, an imaging study of the brain, such as an MRI or CT scan, is usually performed to diagnose its underlying cause. In cases in which the brain imaging study is normal, a lumbar puncture should follow, with measurement of the opening pressure and analysis of the spinal fluid.
How Is Papilledema Treated?
Treatment of papilledema is specific to the underlying cause and involves procedures or medications that will eventually reduce the pressure in the optic discs.
Without treatment, the pressure that causes papilledema can cause visual loss and permanent damage to one or both optic nerves. In addition, untreated increase in pressure inside the head can lead to brain damage.
Treatment options include:
Medication
If you have an infection or organ damage, medications to control those systemic health problems can reduce papilledema and prevent irreversible damage to the brain and eyes. There are also medications that can be used to help decrease the pressure inside the brain and consequently in the optic disc helping with the symptoms.
Lumbar Puncture
Alumbar punctureis normally considered a diagnostic procedure used to evaluate cerebrospinal fluid.
With pseudotumor cerebri or increased intracranial pressure due to excessive fluid, a lumbar puncture can be used as a therapeutic procedure to remove the fluid and relieve the pressure.Also known as a spinal tap, a lumbar puncture involves placing a needle in your lower back to collect fluid from around your spine. It is a mildly uncomfortable procedure, but it is safe, and recovery generally takes a few hours.
Some people develop a post-lumbar puncture headache as the body adjusts to the lowered CSF pressure after fluid removal. But if you have papilledema, you are likely to experience headache relief rather than a new headache.
Your healthcare providers might not do a lumbar puncture if you have a mass in your brain, as the changes in CSF flow and pressure can cause minor changes in the position of the mass and possibly dangerous displacement of the brain itself.
Stop Taking Medications That Cause Pressure
Generally, stopping the medication prevents the worsening of the problem, but it is not enough to completely solve the problem after it has already developed, and you may also need to have a lumbar puncture to decrease the CSF build-up.
Shunting
If you have recurring papilledema due to chronically increased intracranial pressure, you may need to have a drain known as aventriculoperitoneal(VP) shuntor lumboperitoneal shunt surgically placed to maintain a normal fluid volume and pressure.
The VP shunt is usually needed for people who have had a brain tumor that caused blockage of the fluid flow in the brain. The lumboperitoneal shunt is more commonly used for patients with idiopathic intracranial hypertension/pseudotumor cerebri when clinical treatment fails.
Surgery
If you have a tumor or another anatomic cause of your papilledema, you may need to have it surgically removed to relieve the pressure and to prevent permanent vision loss and brain damage.
Most of the time, papilledema can be treated effectively, but repeat treatment may be necessary. It’s important to maintain regular follow-up visits with a practitioner who examines your eyes, even after you have been effectively treated for papilledema.
Summary
Papilledema is swelling of the optic nerve discs in the back of the eye. It can be a sign of conditions affecting the brain, including a brain tumor, meningitis, and head trauma. Symptoms include blurred vision, vision loss, headaches, pain behind the eyes, and fatigue.
Your healthcare provider can diagnose papilledema with an ophthalmoscope or other noninvasive equipment that can look directly behind your eyes. Treatment will depend on the cause of papilledema but may include medication, lumbar puncture, shunting, or surgery.
4 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Mollan SP, Markey KA, Benzimra JD, et al.A practical approach to, diagnosis, assessment and management of idiopathic intracranial hypertension.Pract Neurol. 2014;14(6):380–390. doi:10.1136/practneurol-2014-000821Reiss R, Breden Crouse E.Pharmacist’s guide to pseudotumor cerebri: A review of the condition and its management.Mental Health Clinician. 2013;3(5):244-247. doi:10.9740/mhc.n178413Rigi M, Almarzouqi SJ, Morgan ML, Lee AG.Papilledema: epidemiology, etiology, and clinical management.Eye Brain. 2015;7:47–57. doi:10.2147/EB.S69174Peragallo JH.Effects of brain tumors on vision in children.Int Ophthalmol Clin. 2018;58(4):83-95.Additional ReadingKanagalingam S, Subramanian PS.Update on Idiopathic Intracranial Hypertension. Curr Treat Options Neurol. 2018 May 28;20(7):24. DOI: 10.1007/s11940-018-0512-7.Sinnott JR, Mohebbi MR, Koboldt T.Papilledema: Point-of-Care Ultrasound Diagnosis in the Emergency Department. Clin Pract Cases Emerg Med. 2018 Mar 14;2(2):125-127. DOI: 10.5811/cpcem.2018.1.36369.
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Mollan SP, Markey KA, Benzimra JD, et al.A practical approach to, diagnosis, assessment and management of idiopathic intracranial hypertension.Pract Neurol. 2014;14(6):380–390. doi:10.1136/practneurol-2014-000821Reiss R, Breden Crouse E.Pharmacist’s guide to pseudotumor cerebri: A review of the condition and its management.Mental Health Clinician. 2013;3(5):244-247. doi:10.9740/mhc.n178413Rigi M, Almarzouqi SJ, Morgan ML, Lee AG.Papilledema: epidemiology, etiology, and clinical management.Eye Brain. 2015;7:47–57. doi:10.2147/EB.S69174Peragallo JH.Effects of brain tumors on vision in children.Int Ophthalmol Clin. 2018;58(4):83-95.Additional ReadingKanagalingam S, Subramanian PS.Update on Idiopathic Intracranial Hypertension. Curr Treat Options Neurol. 2018 May 28;20(7):24. DOI: 10.1007/s11940-018-0512-7.Sinnott JR, Mohebbi MR, Koboldt T.Papilledema: Point-of-Care Ultrasound Diagnosis in the Emergency Department. Clin Pract Cases Emerg Med. 2018 Mar 14;2(2):125-127. DOI: 10.5811/cpcem.2018.1.36369.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Mollan SP, Markey KA, Benzimra JD, et al.A practical approach to, diagnosis, assessment and management of idiopathic intracranial hypertension.Pract Neurol. 2014;14(6):380–390. doi:10.1136/practneurol-2014-000821Reiss R, Breden Crouse E.Pharmacist’s guide to pseudotumor cerebri: A review of the condition and its management.Mental Health Clinician. 2013;3(5):244-247. doi:10.9740/mhc.n178413Rigi M, Almarzouqi SJ, Morgan ML, Lee AG.Papilledema: epidemiology, etiology, and clinical management.Eye Brain. 2015;7:47–57. doi:10.2147/EB.S69174Peragallo JH.Effects of brain tumors on vision in children.Int Ophthalmol Clin. 2018;58(4):83-95.
Mollan SP, Markey KA, Benzimra JD, et al.A practical approach to, diagnosis, assessment and management of idiopathic intracranial hypertension.Pract Neurol. 2014;14(6):380–390. doi:10.1136/practneurol-2014-000821
Reiss R, Breden Crouse E.Pharmacist’s guide to pseudotumor cerebri: A review of the condition and its management.Mental Health Clinician. 2013;3(5):244-247. doi:10.9740/mhc.n178413
Rigi M, Almarzouqi SJ, Morgan ML, Lee AG.Papilledema: epidemiology, etiology, and clinical management.Eye Brain. 2015;7:47–57. doi:10.2147/EB.S69174
Peragallo JH.Effects of brain tumors on vision in children.Int Ophthalmol Clin. 2018;58(4):83-95.
Kanagalingam S, Subramanian PS.Update on Idiopathic Intracranial Hypertension. Curr Treat Options Neurol. 2018 May 28;20(7):24. DOI: 10.1007/s11940-018-0512-7.Sinnott JR, Mohebbi MR, Koboldt T.Papilledema: Point-of-Care Ultrasound Diagnosis in the Emergency Department. Clin Pract Cases Emerg Med. 2018 Mar 14;2(2):125-127. DOI: 10.5811/cpcem.2018.1.36369.
Kanagalingam S, Subramanian PS.Update on Idiopathic Intracranial Hypertension. Curr Treat Options Neurol. 2018 May 28;20(7):24. DOI: 10.1007/s11940-018-0512-7.
Sinnott JR, Mohebbi MR, Koboldt T.Papilledema: Point-of-Care Ultrasound Diagnosis in the Emergency Department. Clin Pract Cases Emerg Med. 2018 Mar 14;2(2):125-127. DOI: 10.5811/cpcem.2018.1.36369.
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