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Papilledema

Overview

Consisting of more than 1 million nerve fibers, the optic nerve is responsible for telling your brain what the eye is seeing. Where the optic nerve connects to the retina is the optic disc, an area through which vessels to access the retina. When the optic nerve swells, the condition is known as papilledema. Left untreated, it can lead to permanent loss of vision.

Symptoms

  • Headache that grows worse when lying down
  • Nausea and vomiting
  • Reduced visual field
  • Short spurts of gray, blurred or double vision
  • Sudden difficulty seeing colors

Prevention

  • Eat a healthy, low-fat diet.
  • Exercise regularly to obtain and maintain a healthy weight.
  • Manage high blood pressure with lifestyle modifications and medication.

Risk Factors

  • Abscesses or tumors in the brain
  • Brain hemorrhage (bleeding)
  • Brain-based blood clots (known as dural or cavernous sinus thrombosis)
  • History of head injury or trauma
  • Idiopathic intracranial hypertension (excessive amount of cerebral spinal fluid pressure with no known cause)
  • Meningitis (inflammation of brain tissue covering)
  • Use of corticosteroids, lithium, tetracycline and certain other medications
  • Diagnosis

    • Medical history and symptom review. When increased intracranial pressure causes troublesome symptoms, the first step to diagnosis is a review of your medical history and symptoms.
    • Physical examination. An ophthalmologist will perform an eye exam to determine the presence of optic disc swelling. Because symptoms mimic other eye disorders, further testing is also required.
    • Imaging tests. For definitive diagnosis of papilledema, a variety of imaging exams may be employed. These include specialized angiography, CT, MRI and ultrasound exams.
    • Lumbar puncture. Also referred to as a spinal tap, a lumbar puncture removes spinal fluid with a thin needle. This fluid is then investigated with the goal of finding the cause of increased intracranial pressure.
  • Treatment

    • Lifestyle changes. Weight loss can help reduce optic neuropathy (damage) of any kind, including optic disc swelling.
    • Medication. Some cases of papilledema can be treated with prescription medication, which encourages the body to make less spinal fluid. With less fluid, intracranial pressure reduces. Other cases are caused by medication. In these instances, stopping use of the offending medication is required.
    • Frequent lumbar punctures. When the cause of papilledema is unknown, it may be necessary to regularly remove spinal fluid with a lumbar puncture.
    • Surgery. In certain cases, surgical intervention can remove the root cause of the papilledema. One such surgery involves making small incisions in the optic nerve sheath (which cover the optic nerve). This allows extra fluid to seep out of the swollen optic nerve, ultimately reducing swelling.
  • Follow-up Care

    • Because papilledema can lead to vision loss, regular medical evaluation is essential if you’ve been diagnosed with papilledema. This allows your provider to watch the progress of your condition and make necessary modifications.
    • If medication is prescribed, take the medication as prescribed unless told to stop.
    • Post-surgical recovery varies based on the procedure performed. Follow your provider’s orders strictly.