PAPILLOEDEMA

By;
Mitali Verma
( 71 )
DEFINITION :
• It is the swelling of optic nerve head due to raised ICP.

• It is nearly always bilateral

CAUSES :

 Inflammations such as papillitis, neuroretinitis, and uveitis.

 Ocular hypotony due to any cause.

 Vascular causes include CRVO, uremia, AION.

 Orbital Causes are ; tumours, graves orbitopathy and orbital cellulitis.

 infiltrative conditions like leukemias and lymphomas.

ETIOPATHOGENESIS :
Causes :

1. Congenital conditions include :

• aqueductal stenosis •craniosynostosis.

2. Intracranial space-occupying lesions (ICSOLS) include :

brain tumours,
abscess,
tuberculoma
gumma,
subdural haematoma aneurysms.

3. Intracranial infections such as meningitis and encephalitis may be associated with papilloedema.

4. Intracranial haemorrhages. Cerebral as well as subarachnoid haemorrhage can give rise to papilloedema
which is frequent and considerable
in extent.

5. Obstruction of CSF absorption via arachnoid villi which have been damaged previously.
6. Tumours of spinal cord occasionally give rise to papilloedema.

7. Idiopathic intracranial hypertension (IIH) also known as pseudotumour cerebri, is an important cause of raised
intracranial pressure. It is a poorly understood condition, usually found in young obese women. It is characterised
by chronic headache and bilateral papilloedema without any ICSOLS or enlargement of the ventricles due to
hydrocephalus.

8. Systemic conditions include malignant hypertension, pregnancy induced hypertension (PIH), cardiopulmonary
insufficiency, blood dyscrasias and nephritis.

9. Diffuse cerebral oedema from blunt head trauma may causes papilloedema.

10. Cerebral venous sinus thrombosis may also cause papilloedema.

In majority of the cases with raised intracranial pressure, papilloedema is bilateral. However, unilateral cases as
well as of unequal change do occur with raised intracranial pressure.
A few such conditions are as follows:

1. Foster-Kennedy syndrome. It is associated with olfactory or sphenoidal meningiomata and frontal lobe tumours. In this
condition, there occurs pressure optic atrophy on the side of lesion and papilloedema on the other side (due to raised intracranial
pressure).

2. Pseudo-Foster-Kennedy syndrome. It is characterised by occurrence of unilateral papilloedema associated with raised

intracranial pressure (due to any cause) and a pre-existing optic atrophy (due to any cause) on the other side.
CLINICAL FEATURES :
It can be described under 4 stages :

1. EARLY ( INCIPIENT ) Papilloedema;

Treatment and prognosis:

Papilloedema is a neurological emergency and requires immediate

hospitalisation.

Urgent neuroimaging (CT scan or preferably MRI with a gadolinium

enhancement) may reveal primary pathology.

As a rule unless the causative disease is treatable or cerebral decompression is

done, the course of papilloedema is chronic and ultimate visual prognosis is bad.
 OPTIC ATROPHY
Condition of optic disc following degeneration of optic nerve
-
Occurs as result of any injury to nerve fibres involving in anterior visual system - retina to lateral geniculate
body

CLASSIFICATION :

Ophthalmoscopic Classification
-Primary Optic Atrophy
-Secondary/Post-neuritic Optic Atrophy
-Consecutive Optic Atrophy
-Glaucomatous Optic Atrophy
-Ischaemic Optic Atrophy

Another classification
-Ascending/Anterograde optic atrophy
-Descending/retrograde optic atrophy
Primary optic atrophy
• Disease proximal to the disc so there is no evidence of local inflammation.
• CAUSES: Multiple sclerosis
Space occupying lesions
Leber's disease
Tabes dorsalis

Ophthalmoscopic appearance
1. Disc is chalky white
2. Margins well defined Lamina cribrosa seen
3. Cupping is shallow
4. Retina looks normal
Secondary/Post neuritic Optic Atrophy:

 Break in continuity of fibres in optic disc

 Occurs in longstanding papilloedema, papillitis or neuroretinitis

Ophthalmoscopic Appearance
-Disc- dirty white
-Edges blurred due to gliosis(proliferation of astrocytes & glial tissue)
-Cup obliterated

Consecutive Optic Atrophy:

Occurs following destruction of ganglion cell-secondary to lesions in choroid /retina

Causes;
-Diffuse chorioretinitis
-Retinitis pigmentosa
-Pathological myopia
-Occlusion of central retinal artery
Glaucomatous Atrophy:

Results from long-standing raised IOP

 Ophthalmoscopic Appearence
-Deep & wide cupping of optic disc
-Nasal shift of blood vessels
-Lamina cribrosa pores seen (lamellar dot sign)
Vascular / Ischaemic Optic Atrophy:

. Conditions producing disc ischaemia

Causes
-Giant cell arteritis
-Severe haemorrhage
-Severe anaemia
-Quinine poisoning

Ophthalmoscopic Appearence
-pallor of disc
-marked attenuation of vessels
CLINICAL FEATURES:
1. Loss of vision -partial /total

2. Pupil
-semi-dilated
-direct light reflex-sluggish /absent
-Marcus Gunn pupil/RAPD

3. Visual field loss

-Peripheral, Central /Eccentric
TREATMENT:

 Partial optic atrophy - Treat underlying cause

 If complete atrophy - Vision cannit be recovered

THANK YOU