Papilledema is a condition in which increased pressure in or around the brain causes the optic nerve to swell where it enters the eye.

• Symptoms may be fleeting disturbances in vision, headache, vomiting, or a combination.
• Doctors make the diagnosis by looking in the person's eye with a viewing instrument (ophthalmoscope).
• The disorder causing increased brain pressure is treated as soon as possible.

Causes

The condition is usually caused by the following:

• Brain tumor or abscess
• Head injury
• Bleeding in the brain
• Infection of the brain or its tissue coverings (meninges)
• Idiopathic intracranial hypertension (pseudotumor cerebri, which is not a tumor—see Common Symptoms of Some Brain Tumors)

These conditions typically result in papilledema in both eyes.

Symptoms

At first, papilledema may be present without affecting vision. Fleeting vision changes—blurred vision, double vision, flickering, or complete loss of vision—typically lasting seconds are characteristic of papilledema. Other symptoms may be caused by the elevated pressure in the brain. Headache, nausea, vomiting, or a combination may occur.

Diagnosis

An ophthalmologist uses an ophthalmoscope to diagnose papilledema. Magnetic resonance imaging (MRI) or computed tomography (CT) may be used to help determine the cause and monitor the effect of treatment. A spinal tap is often done to measure the pressure of the cerebrospinal fluid. A sample of the cerebrospinal fluid may be examined for evidence of a brain tumor or infection. Sometimes an ultrasound of the eye is done to distinguish between papilledema and other disorders that cause apparent swelling of the optic nerve.

Treatment

The disorder causing increased brain pressure is treated as soon as possible. For example, if the high pressure of the cerebrospinal fluid is caused by a brain tumor, corticosteroids may be given, but surgery to remove the tumor may be needed. Papilledema that occurs as a result of idiopathic intracranial hypertension can be treated with weight loss and a diuretic. An infection, if bacterial, can be treated with antibiotics. A brain abscess is drained, and antibiotics are given.

Last full review/revision July 2008 by James Garrity, MD