Neuro-ophthalmology
What is papilloedema?
Papilloedema is swelling of both optic discs caused by raised pressure inside the head. Symptoms may include headache that is worse on waking, bending or straining, brief blackouts of vision lasting seconds, double vision and ringing in the ears. It is found on eye examination and always needs prompt investigation to identify the cause.
Why it happens
The fluid around the brain and the optic nerves is under pressure. If that pressure rises, it is transmitted along the optic nerves and the discs swell where they enter the eye. Causes include a mass inside the head, blockage of fluid drainage, a blood clot in a vein draining the brain, certain medications and raised pressure without an identified mass, which is more common in younger overweight adults.
Symptoms to be aware of
- Headache that is worse in the morning, or on coughing, bending or straining
- Vision blacking out briefly, often on standing or bending
- Double vision, usually horizontal
- A whooshing or pulsing sound in the ears
- Nausea or vomiting
- Gradual loss of side vision in longer standing cases
Assessment
Both optic discs are examined after dilation, and imaging of the optic nerves with optical coherence tomography and formal visual field testing document the extent. Brain imaging is required to look for a cause, and measurement of the fluid pressure may be needed. Blood pressure is checked, since very high blood pressure can produce a similar appearance.
Treatment
Treatment is directed at the underlying cause and is managed together with neurology or neurosurgery. Lowering the pressure protects the optic nerves, and repeated visual field tests are used to monitor whether the nerves are being affected. Where a medicine or weight is contributing, that is addressed with the treating clinicians rather than independently.
When to seek urgent assessment
- Severe or sudden headache with vomiting, which needs emergency care
- Repeated brief blackouts of vision, or vision that is progressively worsening
- Headache with weakness, numbness, confusion, seizure or a change in consciousness, which needs emergency care
Frequently asked questions
- Is papilloedema the same as a swollen eye?
- No. It refers to swelling of the optic disc inside the eye, seen only on examination, not swelling of the eye or eyelids.
- Can vision be lost permanently?
- Yes, if raised pressure persists untreated, which is why prompt investigation and monitoring of the visual fields are important.
Concerned about these symptoms?
Arrange an eye examination with our consultant ophthalmologist in Garki, Abuja.
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