Papilledema

Updated: May 18, 2016
  • Author: Mitchell V Gossman, MD; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Overview

Background

Papilledema is optic disc swelling that is secondary to elevated intracranial pressure. [1, 2] In contrast to other causes of optic disc swelling, vision usually is well preserved with acute papilledema. Papilledema almost always presents as a bilateral phenomenon and may develop over hours to weeks.

The term, as a matter of definition, is incorrect to be used to describe optic disc swelling with underlying optic nerve infectious, infiltrative, or inflammatory etiologies; but, it is correctly used if the underlying cause of elevated intracranial pressure is infectious, infiltrative, or inflammatory.

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Pathophysiology

The disc swelling in papilledema is the result of axoplasmic flow stasis with intra-axonal edema in the area of the optic disc. [3] The subarachnoid space of the brain is continuous with the optic nerve sheath. Hence, as the cerebrospinal fluid (CSF) pressure increases, the pressure is transmitted to the optic nerve, and the optic nerve sheath acts as a tourniquet to impede axoplasmic transport. This leads to a buildup of material at the level of the lamina cribrosa, resulting in the characteristic swelling of the nerve head. Papilledema may be absent in cases of prior optic atrophy. In these cases, the absence of papilledema is most likely secondary to a decrease in the number of physiologically active nerve fibers.

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Epidemiology

Frequency

United States

Rare

International

Rare

Mortality/Morbidity

Early detection and identification of cause may be life saving.

Race

No racial predilection exists.

Sex

Papilledema affects both sexes equally.

Age

Papilledema can present at any age, though, during infancy, before the fontanelles close, the finding of papilledema may fail to occur despite elevated intracranial pressure.

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