What is papilledema?

Papilledema is a condition in which your optic nerves swell because of high brain pressure. The optic nerves connect your retina to the visual cortex in your brain, and they're considered an extension of brain tissue. These nerves are important because they contain the fibers that send images to your brain, and if damaged, they could prevent you from having clear vision. You might even develop blindness or a life-threatening condition. 

In papilledema, the intracranial fluid that normally surrounds your brain increases in volume and puts a lot of pressure on the optic nerves. When your brain and eyes experience too much pressure, you can develop symptoms like headaches and nausea that may come and go or may remain constant. 

This condition can affect men, women, and children, but women are more likely to develop papilledema. One cause of papilledema is idiopathic intracranial hypertension (IIH), a disorder related to high pressure in the brain. IIH generally only affects women between 18 and 50 who are considered overweight.

Learning the possible signs and main symptoms of papilledema can help you get proper treatment and protect your vision and brain health.

Signs and symptoms of papilledema

Papilledema isn't common, but it can cause permanent damage if left untreated. Since it builds slowly, you may not realize that you have developed high pressure in your brain and eyes. 

Some of the signs and symptoms of papilledema may include:

Headaches

Headaches are the most common symptom of papilledema. These pains are noticeable at any time of day, but often they are worse in the mornings or whenever you lie down, bend over, or exert pressure lifting an object. 

Vomiting and nausea

Another common symptom, nausea and vomiting is often connected with intense headaches. You might also experience dizziness or lightheadedness due to papilledema.

Ringing in the ears

Ringing or whooshing in the ears, similar to a pounding sensation or pulsing heartbeat, may also indicate papilledema. This ringing is known as pulsatile tinnitus and can become quite disruptive, especially in the evenings.

Blurry or double vision

Once papilledema has become more serious, it can lead to vision changes. Blurred or double vision lasts for just a few seconds and may be accompanied by brief flashing lights across your vision.

Visual blackouts

As papilledema progresses, vision changes become longer and more noticeable. Visual blackouts in which your vision turns grey or black can last up to 30 seconds during each event. These blackouts can last longer if you don't receive treatment.

Causes of papilledema

Papilledema can have several causes, and most causes suggest a second underlying medical condition. Causes of papilledema include:

Idiopathic intracranial hypertension

Also known as pseudotumor cerebri, idiopathic intracranial hypertension (IIH) develops from the pressure of too much cerebrospinal fluid. IIH affects women 90 percent of the time and can reoccur in 10 to 20 percent of cases. 

Bleeding in the brain

Bleeding in the brain, also known as a hemorrhage, can increase the pressure on the optic nerve. These hemorrhages are a type of stroke that can occur inside the brain or surrounding the brain when blood vessels rupture.

Brain tumor

Both benign and malignant brain tumors can cause pressure that later affects the connected optic nerve. Many symptoms of papilledema are the same as those of a brain tumor, so it's important to know if you have an associated tumor needing treatment.

Inflammation of brain or brain tissues

You may develop papilledema if you develop encephalitis or meningitis, which are inflammations affecting the brain. These conditions are usually the result of a viral infection, but they may occur from some health disorders as well.

Blood clots

Blood clots in the brain, called cerebral venous sinus thrombosis (CVST), are another cause of papilledema and can lead to permanent damage without medical aid. 

Tests for papilledema

An ophthalmologist will conduct a thorough eye exam to check for signs of swelling in your optic nerve. If they suspect papilledema, they may order additional tests like a CT scan or MRI to check for brain pressure, or a lumbar puncture (spinal tap) to check the fluid pressure in your spine.

Treatments for papilledema

Papilledema treatments depend on the cause and whether there are serious underlying conditions. You may receive medications to reduce fluid in your eyes or overall body fluid, or you may receive anticoagulants if you have a blood clot. For brain tumors, you will likely undergo a biopsy and have potential surgery or medications to shrink the mass.

For excess spinal fluid, you will likely have repeat spinal taps to help relieve the pressure of papilledema symptoms. You may receive recommendations for diet and exercise to improve your overall health. Your doctor may also recommend eye surgery to put a shunt in your optic nerve to improve fluid drainage.

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Medically Reviewed on 3/8/2021
References
SOURCES:

American Stroke Association: "Hemorrhagic Stroke (Bleeds)."

BMC Neurology: "Cases of visual impairment caused by cerebral venous sinus occlusion-induced intracranial hypertension in the absence of headache."

Harvard Health Publishing, Harvard Medical School: "Optic Nerve Swelling (Papilledema)."

Merck Manual: "Idiopathic Intracranial Hypertension."

Merck Manual: "Overview of Brain Tumors."

National Institute of Neurological Disorders and Stroke: "Meningitis and Encephalitis Fact Sheet."

Penn Medicine: "Pulsatile tinnitus."

Rigi M., Almarzouqi S.J., Morgan M.L., Lee A.G. Papilledema: epidemiology, etiology, and clinical management, Eye Brain, 2015.

Stat Pearls: "Optic Nerve Decompression."

Texas Children's Hospital: "Papilledema (Swelling of the Optic Nerve)."