Papilloedema

Last updated 20.05.13

 

Definition

-  Congestion of the opitic disc caused by increased intracranial pressue

-  Detected on eye examination by fundoscopy

 

Features

-  Usually bilateral, may be one side > other

-  Vision usually preserved unless chronic

 

DDx

-  Optic disc swelling due to optic nerve pathology

-  Visual acuity changes

 

Assocaited S/S

-  Headache: IICP

-  Worse of wakening

-  Exacerbated w Vasalva (ie: cough)

-  Nausea & vomiting

-  Pulsatile tinnitus

-  Transient visual obscurations: graying of vision

-  Diplopia: 6th nerve palsy

 

Ix

-  Vitals

-  Temp

-  BP: malignant hypertenion

-  Eye movements: 6th nerve palsy

-  Dilated fundocsopy

-  Early

-  Disc hyperaemia

-  Oedema of nerve fiber layer

-  Small haemorrhages of nerve fiber layer (best seen w green light)

-  Late

-   Gross elevation of disc

-   Peripapillary haemorrhages, exudates & cotton wool spots

-   Paton lines, Choroidal folds

-  Chronic

-  Grey pale disc

-  Disc pseudodrusen

-  Fluorescein angiography

-  CT–Brain: CNS lesion

-  MRI–Brain: CNS lesion

-  Perimetry

-  Enlarged blind spot

-  Speudo-bitemporal hemianopsia

-  ChronicÓ constricted visual field (esp inf.)

-  Stereo color photos of optic discs

 

 

Mx

-  As per cause of IICP

-  Opthalmology

-  +/- Neuro R/V

 

 

 

References