Papilledema

Description

Papilledema is a condition whereby the optic disc, the area where the nerve that goes to your brain connects to your eye, swells following increased intracranial pressure (increased pressure in or around the brain). This condition must be distinguished from optic disc swelling from other causes simply referred to as “optic disc oedema”.  Often this condition is a warning sign of a more serious medical condition such as CNS inflammation, brain tumours, or idiopathic intracranial hypertension (pressure around the brain with no detectable cause). If papilledema is left untreated it can lead to complete vision loss.

Symptoms

Individuals may not have any symptoms of papilledema in the early stages.  Individuals most commonly present with headache due to the increased pressure in the brain, this is usually worse in the morning. Nausea and vomiting are also common symptoms associated with increased pressure, typically following acute (sudden, fast) onset of pressure. When the papilledema is worsening individuals may notice short periods (lasting only seconds) of losing vision Each of these symptoms can cause rapid decline in an individuals’ central vision.

Causes

Papilledema is causes by increased pressure on and around the brain. The increased intracranial pressure can have any number of causes, these can include;
  • Brain tumour or abscess
  • Head injury
  • Bleeding in the brain
  • Inflammation of the brain of its surrounding tissue (meninges)
  • Uncontrolled hypertension (high blood pressure
  • Idiopathic intracranial hypertension (Increased pressure from an unknown cause)

Diagnosis

Papilledema is diagnosed through a number of tests which are important for providing the correct diagnosis. This can include taking clinical tests and medical history. Ophthalmologists may perform imaging tests, such as fundoscopy, which is a pain-free imaging technique that allows for an image of the back of the eye including to optic nerve to be taken. Fundoscopy images are useful in identifying any swelling of the optic disc. These imagine methods also allow the doctor to rule out alternative causes of visual impairment. Papilledema is only diagnosed when there is swelling of the optic disc observed, in addition to an increase in intracranial pressure (pressure on the brain). Intracranial pressure is assessed using a lumbar puncture (procedure where fluid is taken from the spine). It is essential that the lumbar puncture be carried out so that papilledema can be distinguished from other possible conditions that may results in swelling of the optic disc such as;
  • Intraocular inflammation (swelling inside the eye)
  • Central retinal vein occlusion
  • Optic neuritis
  • Thyroid ophthalmopathy
  • Hypertension

Treatment

In order to effectively treat papilledema, the primary cause of the increased intracranial pressure must first be addressed. If a brain tumour or abscess is identified, the primary therapeutic course of action should be directed towards that. If medications are thought to be causative the first line of treatment is to discontinue that medication. There are a number of medications that can be administered to help to reduce intracranial pressure by helping to increase cerebral spinal fluid (CSF) absorption or reduction of CSP production. In some cases steroids can be used to decrease intracranial pressure but these need to be observed with caution as they have also been indicated in causing elevated pressure. As well as medicinal intervention there are a number of surgical interventions that are used to reduce intracranial pressure. Surgical intervention is the first port of call if there is a mass detected and causative of elevated pressure. Two surgical techniques which result in the implant of shunts, ventriculoperitoneal (VP) and lumboperitoneal (LP), are effective in aiding the removal of excess fluid on the brain and help to return intracranial pressure to within normal levels. No matter what level of vision a person may have, it is important to look after the eyes. To find out more about what can be done to take care of the eyes on a daily basis, please visit our Tips for Good Eye Health. For further information, please contact the Research Department on 01 6789004 or email research@fightingblindness.ie.

Research

Researchers and clinicians are continually seeking more effective approaches to treat papilledema. Research areas regarding papilledema are focusing on optimising imaging techniques to accurately diagnose papilledema cases. A clinical trial that is currently underway is investigating the potential of ultrasound imaging my primary care doctors as a way of identifying papilledema without the need for an ophthalmic referral. The aim is to reduce the timeframe in clinic that will lead to an accurate diagnosis. This trial can be viewed in full on the clinical trials website. Information about other clinical trials that are on-going and completed can be found on the clinical trials website and can be searched by both condition and location.

Support

Receiving a diagnosis can be overwhelming for anyone, but this is not a journey that you have to make alone. There are many groups and resources available to provide support for people living with Stargardt Disease. Fighting Blindness offers a free and confidential counselling service (Insight Counselling). For further information please contact insight@fightingblindness.ie or call 01 6746496. We also offer support groups for people with a visual impairment to share their feelings and experiences with others facing the same challenges. Please consult the support groups section of our website here to access the latest timings and days for the various support groups we offer. For further information please contact insightgroups@fightingblindness.ie or call 01 6746496.

Resources

Féach provides support for parents of children living with sight loss in Ireland. ChildVision is the national education centre for children with sight loss in Ireland. Vision Ireland, formerly NCBI (National Council for the Blind in Ireland) provides support and services for people living with sight loss in Ireland. Irish Guide Dogs for the blind helps individuals and their families to achieve improved mobility and independence.