Though many people experience nausea and pressure headaches, in rare cases, an ophthalmologic condition — papilledema — is the cause. Papilledema occurs when the optic disc and the optic nerve at the back of the eyeball become swollen.
What Causes Papilledema?
The swelling of the optic disc and nerve that causes papilledema is related to increased intracranial pressure, rather than inflammation. The condition rarely occurs on its own; it is usually a symptom of an underlying condition. In most cases, it occurs in both eyes at the same time,although it can occur in only one eye.
Intracranial Pressure Related and Papilledema
Intracranial pressure (ICP) can be caused by lesions in the brain or a build-up of fluid, called edema. The nerves keep the brain, cerebral spinal fluid, and blood in balance to prevent ICP. If the brain sustains an injury or the pressure is somehow elevated by a growth, however, the volume of another component must decrease to compensate. If the optic nerve is the one that compensates, swelling or papilledema can result.
Symptoms of Papilledema
Papilledema usually does not cause pain. However, most people experience symptoms such as blurred, double, or grayed-out vision. Other visual problems, like temporary blindness, may also occur. Because of the pressure on the brain, people with papilledema may experience neurological symptoms, such as nausea, vomiting, and headaches.
Does Papilledema Progress?
Papilledema can cause ocular damage if left untreated, leading to blurred vision and other abnormalities. Central or total blindness may also develop. If an underlying disease or problem is present, doctors will likely treat both the condition and the visual symptoms, as correcting the cause of the papilledema can ease its effects.
Diagnosing Papilledema
An ophthalmologist may discover papilledema during an ophthalmoscopy. During this routine test, the patient reclines while the doctor shines a light into the eye to see the nerves and vessels behind it. Papilledemas can be misdiagnosed, so a doctor who suspects the issue may order an MRI to gain insight into any issues in the brain.
Papilledema as a Hallmark of Other Diseases
Papilledema is not a standalone disease. It is typically a hallmark of a tumor, physical trauma, meningitis, or cerebral venous thrombosis. Other potential causes include idiopathic intracranial hypertension and encephalitis. Some medications can cause papilledema too, including corticosteroids, isotretinoin, lithium, and tetracycline. Diagnosing the underlying condition is crucial to resolving the visual issues and preventing progression.
Papilledema and Encephalitis
Encephalitis is swelling in the brain and is often the result of a viral infection, though immune disorders can also prompt it. Not all forms of encephalitis cause papilledema; it is a rare symptom. However, severe cases of encephalitis can be life-threatening. Doctors will likely test for encephalitis if they diagnose papilledema.
Idiopathic Intracranial Hypertension and Papilledema
Idiopathic intracranial hypertension is also called pseudotumor cerebri. Pressure increases around the brain and mimics the symptoms of a brain tumor, although no tumor is present. The increased pressure is caused by cerebrospinal fluid build-up. One of the symptoms of the chronic form of this disease is papilledema and similar visual problems.
Who Is at Risk of Developing Papilledema?
Papilledema is most common in women with obesity of childbearing age. Idiopathic intracranial hypertension is also most common in women of this age group and weight bracket. Other risk factors include brain tumors and trauma to the head and spinal cord that cause swelling or a build-up of fluid. Some professionals believe that having diabetes and hypertension increase the risk, as well.
How is Papilledema Treated?
Doctors treat papilledema by addressing the underlying condition causing the swelling. For people who are obese, weight management is often effective in relieving intracranial pressure if another disease is not the cause. Medication and surgery are often successful in treating underlying conditions such as tumors and encephalitis, and thereby correcting papilledema, as well.