Papilledema

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at September 26, 2016
StartDiseasesPapilledema

Papilledema is an eye disorder in which pressure on the back of the eyes causes blind spots and other vision problems. The condition can only cause blindness if it remains untreated for a very long period of time. The main cause of concern with papilledema is finding out where the pressure is coming from. It can often be a sign of high blood pressure (hypertension), but it sometimes occurs as the result of a brain tumor

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Definition & Facts

Papilledema is the inflammation of the optic disc in the back of the eye. This is caused by an increase in pressure, usually from an excess of cerebrospinal fluid. This can occur as the result of a brain tumor, brain injury, or high blood pressure. It can also occur as a result of hormonal changes in women who are overweight or pregnant. Papilledema is considered a rare condition in both the United States and internationally. It addresses various races and both genders with the same frequency.

Symptoms & Complaints

Symptoms include headaches or nausea and vomiting. Many patients report hearing a sound similar to machines ringing in their ears. One in four people will have some sort of distortion in vision. The vision of the patient will go grey or black for usually less than a minute and it is described as if a veil has been put over their eyes.

These blackouts are triggered by certain swift changes in body position such as getting up quickly, coughing, or shifts in motion affecting the stomach or abdomen.

Sometimes patients will report instances where they see pulsing lights in the shape of a curved line. Over time, the patient could end up with a blind spot or even permanent blindness if the condition is not treated. With papilledema, both eyes are affected simultaneously (is bilateral). 

Causes 

There are a lot of different causes for papilledema. All of them involve various ways of putting too much pressure on the back of the eye. The most common causes are a brain tumor and hypertension. Sometimes a person who undergoes continuous positive airway pressure (CPAP) therapy to treat sleep apnea will end up with papilledema due to the airway pressure used during the process.

Taking too many vitamin supplements can actually cause papilledema through the development of a condition called hypervitaminosis A. Medulloblastoma, Foster-Kennedy syndrome, and Lyme disease all can lead to papilledema.

It is important to be aware of the effect that high elevation can do to the brain and eyes. Mountain climbers are exposed to thin air and a lack of oxygen on mountain peaks, a situation that is much more debilitating than it sounds. If a climber acquires acute mountain sickness, they may also end up with a severe case of papillema. This also applies to astronauts and those who experience weightlessness over a long period of time. 

Diagnosis & Tests

When checking a patient for papilledema, a doctor will use an ophthalmoscope to peer into the eyes. The source of this condition is in the back of each eye at an area called the optic disc. The doctor will take a look and usually they can diagnose papilledema just from visual observation. Generally, if the optic disc has a blurred edge or looks like it is elevated, then the patient likely has papilledema.

Veins in the eye might be congested and the normal small pulsing of the veins will not be apparent. In extreme cases, there might be red spots from internal bleeding or changes to the color of the retina due to damage or debris.

The physician will check each eye to look for blind spots and they will test the peripheral vision by asking the patient to follow their hand movements. They might also use a vision grid. If papilledema is present, it requires immediate medical attention, though permanent blindness is unlikely unless the condition has been present for a very long time.

The real concern is that it might be evidence of brain swelling. A computed tomography (CT) scan or a magnetic resonance imaging (MRI) will be performed to take a look at the brain. If the brain scan comes out fine, then a patient will undergo a spinal tap (lumbar puncture) so that the doctor can evaluate the cerebrospinal fluid. If a brain tumor is suspected to be the source of the problem, a biopsy may be performed in which tissue is extracted from the brain and examined in a laboratory.

Treatment & Therapy

The treatment of papilledema varies depending on what caused the condition in the first place. Sometimes, a brain tumor can be dealt with using radiation or laser surgery. Blood pressure need to be carefully maintained during this process, as high blood pressure can exacerbate the condition. If the cause is pseudotumor cerebri (also called idiopathic intracranial hypertension), it can be dealt with through a series of shunts. This process allows the doctor to remove the excess amount of spinal fluid. If the spinal taps are not effective, then surgery is the likely next step.

Physicians might prescribe acetazolamide, a diuretic which can slow down the body's production of cerebrospinal fluid. For those who are obese or overweight, weight loss in order to achieve a healthy weight is extremely beneficial in treating this condition. Those with pseudotumor cerebri will need to monitor their condition, as it remains for a long period of time and can cause permanent loss of vision if the care plan is not followed. 

Prevention & Prophylaxis

Preventing papilledema is difficult to definitively achieve because it can be caused by so many different things. It is absolutely essential to maintain a healthy weight and blood pressure. High blood pressure has many debilitating effects and papilledema is just one of many conditions that can arise due to high blood pressure.

Mountain climbers need to be extremely careful at high altitudes, as most people underestimate the effects of thin mountain air. It is also important to get regular eye examinations. This condition can't do damage unless it goes unchecked for a long period of time, so anyone who deals with it when the first signs appear will generally not need to worry about permanent loss of vision.