Papilledema Treatment & Management

  • Author: Mitchell V Gossman, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 15, 2012
 

Medical Care

  • Therapy, whether medical or surgical, is tailored to the underlying pathological process and the progression of the ocular findings.
  • Specific therapy should be directed to the underlying mass lesion if present.
  • Diuretics: The carbonic anhydrase inhibitor, acetazolamide (Diamox), may be useful in selected cases, especially cases of idiopathic intracranial hypertension. (In the presence of venous sinus thrombosis, diuretics are contraindicated. In this scenario, evaluation by a hematologist is recommended.)
  • Weight reduction is recommended in cases of idiopathic intracranial hypertension and can be curative.[7] Bariatric surgery may be considered in cases refractory to conventional methods of weight loss.[8]
  • Corticosteroids may be effective in cases associated with inflammatory disorders (eg, sarcoidosis).
  • Consider withdrawing causative medications, as weighed against other medical necessities and alternatives.
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Surgical Care

  • The underlying mass lesion, if present, should be removed.
  • Lumboperitoneal shunt or ventriculoperitoneal shunt can be used to bypass CSF.
  • Optic nerve sheath decompression can be used to relieve worsening ocular symptoms in cases of medically uncontrolled idiopathic intracranial hypertension. This procedure probably will not ameliorate persistent headaches if present.
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Consultations

Besides an ophthalmologist, a neurologist should be involved in monitoring the patient, and a neurosurgeon may be needed to help evaluate any underlying mass or to perform a shunting procedure.

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Diet

Dietary restrictions and consultation with a dietitian in case of idiopathic intracranial hypertension is recommended.

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Contributor Information and Disclosures
Author

Mitchell V Gossman, MD  Partner and Vice President, Eye Surgeons and Physicians, St Cloud

Mitchell V Gossman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, Minnesota Medical Association, North American Neuro-Ophthalmology Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Joseph Giovannini, MD  Chief of Ophthalmology, Eye Surgery Center, David Grant Medical Center, Travis Air Force Base

Joseph Giovannini, MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Edsel Ing, MD, FRCSC  Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Consulting Staff, Toronto East General Hospital, Canada

Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Ophthalmological Society, North American Neuro-Ophthalmology Society, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Brian R Younge, MD  Professor of Ophthalmology, Mayo Clinic School of Medicine

Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor, Georgia Chrousos, MD, to the development and writing of this article.

References

  1. Ehlers JP, Shah CP, eds. Papilledema. In: The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. 5th ed. Baltimore, Md: Lippincott Williams & Wilkins; 2008:252-254.

  2. Miller NR, Newman NJ, et al, eds. Walsh & Hoyt's Clinical Neuro-ophthalmology: The Essentials. 2nd ed. Lippincott Williams & Wilkins; 2008:122-145.

  3. Sinclair AJ, Burdon MA, Nightingale PG, Matthews TD, Jacks A, Lawden M, et al. Rating papilloedema: an evaluation of the Frisén classification in idiopathic intracranial hypertension. J Neurol. Jan 12 2012;[Medline].

  4. Scott CJ, Kardon RH, Lee AG, Frisén L, Wall M. Diagnosis and grading of papilledema in patients with raised intracranial pressure using optical coherence tomography vs clinical expert assessment using a clinical staging scale. Arch Ophthalmol. Jun 2010;128(6):705-11. [Medline].

  5. Mathews MK, Sergott RC, Savino PJ. Pseudotumor cerebri. Curr Opin Ophthalmol. Dec 2003;14(6):364-70. [Medline].

  6. Vaphiades MS. The disk edema dilemma. Surv Ophthalmol. Mar-Apr 2002;47(2):183-8. [Medline].

  7. Faz G, Butler IJ, Koenig MK. Incidence of papilledema and obesity in children diagnosed with idiopathic 'benign' intracranial hypertension: case series and review. J Child Neurol. Nov 2010;25(11):1389-92. [Medline]. [Full Text].

  8. Nadkarni T, Rekate HL, Wallace D. Resolution of pseudotumor cerebri after bariatric surgery for related obesity. Case report. J Neurosurg. Nov 2004;101(5):878-80. [Medline].

  9. Acheson JF, Sanders MD. Common Problems in Neuro-ophthalmology. 1997:78-84.

  10. Kline LB. Optic Nerve Disorders, Ophthalmology Monographs. American Academy of Ophthalmology. 1996;37-53.

  11. Yanoff M, Duker JS. Ophthalmology. 1999:11.5.1-5.4.

 
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