Papilledema overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]

Papilledema is defined as swelling of the optic disc that is caused by increased intracranial pressure. The swelling is usually bilateral and can occur over a period of hours to weeks. Unilateral presentation is extremely rare.

Papilledema is in general the result of transmission of increased intracranial pressure^[1] to the anterior end of optic nerve through optic nerve sheath.

Papilledema can be caused by conditions which increase intracranial pressure. An increase in the volume of any of the cranium contents, the brain, cerebrospinal fluid and / or blood can cause increased intracranial pressure.

Papilledema occurs in approximately 50% of patients with a brain tumor.

Papilledema should be distinguished from pseudopapilledema

Papilledema regresses if the underlying cause is treated and if not, can lead to vision loss.

Patients with papilledema usually present with signs and symptoms of increased intracranial pressure (headache, nausea, vomiting, diplopia, vision loss and altered consciousness) and can lead to vision loss if the underlying condition is not treated.

The signs of papilledema include blurring of the margins of the optic disc, edema, and hemorrhages on fundoscopy.

The mainstay of treatment of papilledema is to treat the underlying cause which is often increased intracranial pressure. Drugs are used to decrease intracranial pressure which either decrease cerebrospinal fluid (CSF) production or increase the outflow of CSF.

Surgical treatment of papilledema depends on the underlying cause. Various surgeries including shunt surgeries, craniotomies and optic nerve sheath fenestration can be done depending on the cause.

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