Papilloedema

NEURO-OPHTHALMOLOGY: Papilloedema

Definition
– swelling and vascular congestion of the optic disc – with blurring of disc margins, haemorrhages and venous dilatation.

Aetiology
- Hypertension – always associated with severe hypertensive retinopathy
- Raised intracranial pressure – vision will be normal and visual fields show only enlargement of the blind spot in the early stages. Differential Diagnosis
- Papillitis – an identical appearance of the optic disc. But vision is profoundly disturbed – (central scotoma)
-Toxic optic neuropathy
- Demyelination
- Pseudopapilloedema – blurred disc margins due to hypermetropia. No venous congestion.
A congested swollen disc without raised intracranial pressure, also occurs with chronic cyanotic cardiac and pulmonary disease due to carbon dioxide retention.

Management of Papilloedema
Full neurological examination and investigation is required to exclude possible causes of raised intracranial pressure.
eg – Space occupying lesions
- Infective causes
- Benign intracranial hypertension

If papilloedema is not relieved permanent loss of vision and constriction of fields (with optic atrophy) may result.