(Optic Nerve Swelling)

“Papilledema” refers to optic nerve swelling associated with high pressure in the brain.  The brain, spinal cord, and optic nerves are all bathed in a fluid called cerebrospinal fluid (CSF). This fluid helps to cushion the delicate organs of our nervous system from injury. The fluid also provides essential nutrients.

When the CSF pressure around the brain is high, there is also increased pressure around the optic nerve. This causes the optic nerve to swell inside the back of the eye (See Figure B). If the swelling continues for a while or if the swelling is severe, then visual loss may occur.

The main causes of raised CSF pressure around the brain and optic nerves include idiopathic intracranial hypertension (a.k.a., pseudotumor cerebri), meningitis, brain tumors, or blood clots in the veins that drain the fluid (venous sinus thrombosis).

Symptoms of increased intracranial pressure include headaches, neck stiffness, nausea, vomiting, hearing swooshing noises in the ear coinciding with the heart beat, and episodes of temporary vision loss in both eyes lasting seconds.

To diagnose papilledema, Dr. Banik will perform a complete neuro-ophthalmic evaluation. This includes a detailed eye exam, peripheral vision testing, and sometimes special pictures of the optic nerve. MRI of the brain and MR Venogram are usually performed followed by a spinal tap (or lumbar puncture) to check the cerebrospinal fluid pressure.

Treatment of papilledema is to lower CSF pressure is directed at the underlying cause and may involve medication. Rarely, urgent surgery is required.  If not treated appropriately, the chronic swelling may cause permanent damage to the optic nerve with loss of peripheral vision, followed by central vision.

Figure A: Normal Optic Nerve Appearance

Figure B: Swollen Optic Nerve From Papilledema

Whether Rudrani Banik, MD is the first Neuro-Ophthalmologist you are visiting for treatment of papilledema, or the last one, she will make sure she does everything in her power to find an effective treatment to help you see and function better.