Papilloedema

What's going on?

Raised intracranial pressure results in compromised axonal flow along both optic nerves. Both discs become swollen. Vision is often normal but the blind spot is increased. Patients may complain of transient visual disturbance often associated with movement, such as on standing up, for example. Prolonged raised intracranial pressure with papilloedema will result in permanent constriction of the visual field.

If I examine the patient, what will I find?

The disc margins will be blurred and indistinct. The striations of the engorged retinal nerve fibres will be noticeable, radiating from the optic disc.

What if I've diagnosed it?

Refer to physicians/neurologists.

What will the hospital do?

Neuro-imaging will be used to determine whether there is a mass lesion in the brain, and a lumbar puncture may be done.

What to tell the patient

The nerve at the back of the eye appears swollen. This can be a sign of raised pressure in the head, which needs investigating. There are multiple causes.

Problems that may arise, and how to deal with them

Differentiating true optic disc swelling from 'pseudo-swelling' can be difficult. See Pseudopapilloedema.