EC Ophthalmology

A swelling of the optic nerve head caused by an increase in intracranial pressure is known as papilledema (ICP). Unlike other forms of disc edema, it frequently presents with normal visual function throughout the acute period. We should rule out pseudo papilledema and suspect an intracranial tumor while assessing the patient. Axoplasmic transport inside ganglion cell axons is impeded by high intracranial pressure (ICP) that is transmitted to the subarachnoid area surrounding the optic nerve, resulting in papilledema. There is an ongoing debate about whether microvascular ischemia or physical constriction of axons causes axoplasmic flow standstill. The most common cause of papilledema is idiopathic intracranial hypertension (IIH), which can also result from space-occupying intracranial lesions, meningitis, subarachnoid hemorrhage or trauma, cerebral venous thrombosis, cerebral edema from blunt trauma to the head, severe systemic hypertension, and very rarely, hypersecretion of CSF by a choroid plexus tumor. Clinical features include headache (early morning), nausea (projectile), deterioration of consciousness, transient visual obscuration (vision is generally normal), and horizontal diplopia. Magnetic resonance imaging (MRI) of the brain and orbits, neck, and spine, with venography sequences is the preferred neuroimaging modality performed to look for indirect imaging signs of increased ICP and to rule out non-idiopathic causes. Lumbar puncture with measurement of opening pressure and evaluation of CSF composition. Computed tomography of the chest, complete blood count, and creatinine testing should be able to identify most secondary causes of intracranial hypertension. The underlying cause of papilledema patients' symptoms should be the focus of their treatment.

 Keywords: Papilledema; Idiopathic Intracranial Hypertension; Pseudopapilledema

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