Papilledema

Swelling of the optic disc caused by increased pressure inside the skull. An important finding that requires urgent evaluation to identify the underlying cause.

Papilledema is swelling of the optic disc specifically caused by elevated intracranial pressure (increased pressure inside the skull). It's usually bilateral (both eyes) and is an important warning sign that requires urgent investigation.

Key Takeaways

Optic disc swelling from elevated intracranial pressure
Usually affects both eyes
Urgent evaluation needed to find the cause
Vision may be normal initially but at risk
Different from other causes of disc swelling

Papilledema vs. Disc Edema

While often used interchangeably, technically:

Papilledema: Disc swelling from elevated intracranial pressure
Disc edema: Disc swelling from any cause

This distinction matters because papilledema specifically indicates a problem with brain pressure.

Causes of Elevated Intracranial Pressure

Space-Occupying Lesions

Brain tumor
Brain abscess
Hemorrhage

Obstruction of CSF Flow

Hydrocephalus
Blocked ventricular system

Increased CSF Production

Choroid plexus tumor (rare)

Venous Outflow Obstruction

Cerebral venous sinus thrombosis
Jugular vein compression

Idiopathic Intracranial Hypertension (IIH)

No identifiable cause
Most common in young overweight women
See Idiopathic Intracranial Hypertension

Symptoms

Early

May have no visual symptoms
Headaches (often worse in morning or with straining)
Transient visual obscurations (brief dimming of vision)
Pulsatile tinnitus (whooshing sound in ears)

Progressive

Enlarged blind spots on visual field testing
Peripheral vision loss
Double vision (from sixth nerve palsy)

Late

Severe vision loss
Permanent visual damage if untreated

Clinical Appearance

Early Papilledema

Blurred disc margins
Hyperemia (redness) of disc
Loss of spontaneous venous pulsations
Subtle elevation

Established Papilledema

Elevated disc with obscured vessels
Peripapillary hemorrhages
Cotton wool spots
Exudates

Chronic Papilledema

Disc pallor developing
Vessel sheathing
"Champagne cork" appearance

Atrophic

Pale, flat disc
Permanent vision loss

Diagnosis

Eye Examination

Dilated fundus examination
Both eyes examined
Document appearance

Visual Field Testing

Visual field test
Look for enlarged blind spots
Monitor for progression

Brain Imaging

MRI brain with MR venogram
Rule out mass lesion
Evaluate venous sinuses
Look for signs of elevated pressure

Lumbar Puncture

Lumbar puncture after imaging
Measure opening pressure
Analyze CSF (infection, malignancy)
Only if no mass lesion on imaging

OCT

OCT of optic nerve
Quantifies swelling
Monitors changes over time

Treatment

Treatment depends on the underlying cause:

Mass Lesion

Neurosurgical intervention
Treatment of tumor or abscess

Cerebral Venous Thrombosis

Anticoagulation
Sometimes intervention

Idiopathic Intracranial Hypertension

Weight loss
Acetazolamide
Topiramate
Optic nerve sheath fenestration if medical therapy fails
VP shunt in some cases
See IIH

When to Seek Urgent Care

Seek emergency evaluation if you have:

Severe headache with vision changes
New double vision with headache
Brief episodes of vision going dark
Swollen optic disc found on examination

Papilledema can indicate a brain tumor or other serious condition requiring urgent treatment.

Prognosis

Depends on underlying cause
Early treatment prevents vision loss
Chronic papilledema can cause permanent optic atrophy
Regular monitoring essential

Related Conditions

Medically Reviewed Content

This article meets our editorial standards

Written by:: Hashemi Eye Care Medical Team
Medically reviewed by:: Board-Certified Neuro-Ophthalmologist (MD, Neuro-Ophthalmology)
Last reviewed:: January 30, 2025

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