Papilledema

Papilledema / Papilloedema

Papilloedema simply means swelling of the papilla - the optic disc. There are many causes. In all forms of disc oedema there is axonal swelling within the optic nerve, blockage of axonal transport with capillary and venous congestion. Optic neuritis is swelling of the disc and inflammation within the nerve.

The earliest ophthalmoscopic signs of disc swelling are pinkness of the disc followed by blurring and heaping up of its margins, the nasal first. There is loss within the disc of the normal, visible, spontaneous pulsation of the retinal veins. The physiological cup becomes obliterated, the disc engorged and its vessels dilated. Small haemorrhages often surround the disc.

Various conditions simulate true disc oedema. Marked hypermetropic (long-sighted) refractive errors make the disc appear pink, distant and ill-defined. Opaque (myelinated) nerve fibres at the disc margin and hyaline bodies (drusen) can be mistaken for disc swelling.

Disc infiltration also causes first a prominent, then a swollen disc with raised margins (e.g. in leukaemia).

When there is doubt about disc oedema, fluorescein angiography is diagnostic. Fluorescein is injected intravenously: when there is oedema, retinal leakage is seen and photographed.

Early papilloedema from causes other than optic neuritis (see below) often produces few visual symptoms - the underlying disease is the source of the patient's complaints. However, as disc oedema progresses, enlargement of the blind spot and blurring of vision develop. The disc becomes engorged, reducing its arterial blood flow and, then as papilloedema worsens, infarction of the nerve occurs. This causes sudden severe and permanent visual loss.

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