Papilloedema
Papilloedema refers to optic disc swelling caused by raised intracranial pressure. It is a clinical sign rather than a diagnosis, and should be distinguished from other causes of optic disc swelling.
Updated UKMLA guide to papilloedema: causes, symptoms, diagnosis, assessment and management.
Causes
Causes of papilloedema are essentially causes of ↑ ICP: [Ref]
| Category | Causes |
|---|---|
| Increase in brain tissue | Space-occupying lesion (mass effect)
|
Cerebral oedema (increase in brain volume)
|
|
| Increase in blood volume |
|
| Increase in CSF |
|
Other causes: [Ref]
- Idiopathic intracranial hypertension (IIH)
- Secondary drug causes
- Tetracyclines
- Retinoids / vitamin A derivatives
- Growth hormone
- Lithium
- Corticosteroid withdrawal
Papilloedema ≠ optic disc swelling
- Optic disc swelling = a broad fundoscopy finding where the optic nerve head appears swollen, from any cause
- Papilloedema = optic disc swelling directly caused by raised ICP
Causes of optic disc swelling with no raised ICP (non-papilloedema):
- Optic neuritis
- Anterior ischaemic optic neuropathy
- Giant cell arteritis
- CRVO
- Malignant hypertension
- Compressive optic neuropathy and ocular trauma
Clinical Features
Papilloedema is a clinical sign of raised ICP, rather than a diagnosis.
| Signs of optic disc swelling on fundoscopy | Bilateral findings (can appear asymmetrically, but rarely unilateral):
|
| Signs and symptoms of raised ICP |
|
Assessment and Management
Papilloedema requires urgent specialist assessment and management.
Since papilloedema is secondary to raised ICP, assessment and management would follow those of raised ICP as covered in the Raised Intracranial Pressure (ICP) article.