47- Papilloedema. Inflammation of the optic nerve- papillitis, retrobulbar neuritis
Papilloedema
Swelling of the optic nerve that is caused by increased intracranial pressure.
Etiology:
- Raised intracranial pressure: space-occupying lesion, hydrocephalus, and idiopathic intracranial hypertension (IIH). • Malignant hypertension
- Diabetic papillopathy
- Infiltrative papilloedema such as lymphoma
- Toxic, such as ethambutol.
- Trauma
Clinical features
- Visual acuity may be normal or severely reduced.
- Patients with papilloedema may complain of episodes of unilateral or bilateral transient visual loss lasting for a few seconds. These are transient visual obscurations (TVOs) and can be precipitated by changes in posture.
- Colour vision is often reduced.
- Enlarged blind spot if the swelling is significant; it will be normal in mild cases.
Investigations
- Blood pressure
- Glucose, FBC and differential white cell count, U&E, creatinine and ESR
- Neuroimaging
- Lumbar puncture if the MRI is normal and IIH is suspected
- Visual fields (to monitor blind spot).
Treatment:
The treatment depends largely on the underlying cause. A biopsy is routinely performed prior to the treatment in the initial stages of papilledema to detect whether a brain tumor is present. To decrease ICP, medications can be administered by increasing the absorption of cerebrospinal fluid, or decreasing its production. Such medicines include diuretics like acetazolamide and furosemide. These diuretics, along with surgical interventions, can also treat IIH.