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Papilledema Clinical

Papilledema is a bilateral, non-inflammatory

passive swelling of the optic disc, produced
by an increase in intracranial tension.
Papilledema is one of the causes of disc
edema and they are not synonymous. The
other causes of disc edema are mentioned
below.
- Unilateral causes of disc edema are
sometimes due to a local inflammation,
vascular disorders or compressive lesions
in the orbit.
- Unilateral papilledema with optic atrophy
suggests a frontal lobe tumour or olfactory
meningioma of the opposite side the Symptoms
Foster Kennedy syndrome. - Headache
- Papilledema does not develop if the optic - Vomiting without nausea
nerve has already become atrophic
- Focal neurological deficit with changes in
Causes of Papilledema level of consciousness.
- Congenital Aqueductual stenosis, cranio - Ocular symptoms
synostosis o Visual acuity remains fairly normal
- Space occupying intracranial lesions until the late stage of the disease when
the lesion itself cause a hemianopia
- Head injury
o Amaurosis fugax a transient black
- Microbial infection chronic meningitis,
out of vision for a few seconds may be
encephalitis
present in some patients
- Malignant hypertension
- Metabolic disorder Addisons disease, Signs
diabetic ketoacidosis - Pupillary reactions are normal, until the
- Pseudotumour cerebri due to durg secondary optic atrophy sets in
toxicity, oral contraceptives and cortico - Ophthalmoscopy the features are
steroids different in different stages of the disease.
- Blood dyscrasias Leukemias,
Polycythemia Early Papilledema
- Miscellaneous Sarcoidosis, Serum 1. Earliest changes are blurring of superior
sickness, Status epilepticus and inferior margins of the disc.

Intracranial - within the skull; Hemianopia - blindness over half the field of vision

Compassion Jan - Mar, 2016

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2. Disc hyperaemia and dilated capillaries.
3. Normal optic disc cup is preserved.
Established Papilledema
1. Disc margin becomes indistinct and
central cup is obliterated
2. Venous engorgement and peripapillary
edema
3. Flame shaped haemorrhages and cotton
wool spots
4. Radiating folds around the macula,
Macular Star
Chronic Papilledema
1. Central cup remains obliterated
2. The haemorrhagic and exudative
components gradually resolve
3. Optic disc appears as a Champagne cork.
Atrophic papilledema
1. Retinal vessels are attenuated with
perivascular sheathing.
Obliterate - invisible; Engorge - swelling; Sheathing - covering
A R A V I N D E Y E C A R E
2. Dirty white appearance of the optic
disc due to reactive gliosis leading to
secondary optic atrophy.
Field changes
- In early stage there is no field defect
- In established stage there is enlargement
of the blind spot.
- In chronic stage there is associated
peripheral constriction of the visual field
with appearance of nerve fibre bundle
defects.
- Finally there is total loss of visual field.
- In addition, the lesion itself may cause
hemianopia or quadrantic field defect.
Treatment
- Treatment must be directed to detect the
cause and then to treat it.
- Surgical decompression of the optic nerve
may be indicated to preserve vision
- Sr. P. Revathi,
Ward, Aravind - Madurai
S Y S T E M