(See also Overview of Optic Nerve Disorders.)
Causes
Papilledema is usually caused by the following:
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Brain tumor or abscess
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Bleeding in the brain
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Inflammation of the brain (encephalitis) or its tissue coverings (meningitis)
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Uncontrolled, life-threatening hypertension
These conditions typically result in papilledema in both eyes.
Symptoms
At first, papilledema may be present without affecting vision. Fleeting vision changes—blurred vision, double vision, flickering, or complete loss of vision—typically lasting seconds are characteristic of papilledema. Other symptoms may be caused by the elevated pressure in the brain. Headache, nausea, vomiting, or a combination may occur. This disorder does not cause pain.
Diagnosis
To diagnose papilledema, a doctor uses an ophthalmoscope (a light with magnifying lenses that is used to look into the back of the eye). Often an ophthalmologist (a medical doctor who specializes in the evaluation and treatment of eye disorders) needs to confirm the diagnosis and help determine the cause.
Magnetic resonance imaging (MRI) or computed tomography (CT) may be used to help determine the cause and monitor the effect of treatment.
A lumbar puncture (spinal tap) is done to measure the pressure of the cerebrospinal fluid unless something is seen on the MRI or CT scan indicating a spinal tap is not safe to do. A sample of the cerebrospinal fluid may be examined for evidence of a brain tumor or infection.
Sometimes ultrasonography of the eye is done to distinguish between papilledema and other disorders that cause apparent swelling of the optic nerve.
Treatment
The disorder causing increased brain pressure is treated as soon as possible. For example, if the high pressure of the cerebrospinal fluid is caused by a brain tumor, corticosteroids may be given, but surgery to remove the tumor or radiation therapy to decrease its size may be needed.
Papilledema that occurs as a result of idiopathic intracranial hypertension can be treated with weight loss and a diuretic. If unsuccessful, surgical procedures can be done.
An infection, if bacterial, can be treated with antibiotics.
A brain abscess is drained, and antibiotics are given.
