Also called Disc oedema Passive disc swelling associated with increased intra cranial pressure Bilateral and asymmetrical Inflammations such as papillitis, neuroretinitis, papillophlebitis and uveitis. Ocular hypotony CRVO, AION (anterior ischemic optic neuropathy) and uremia Orbital causes – tumors, grave’s orbitopathy and orbital cellulitis Leukemia and lymphomas

1. PAPILLOEDEMA By S. Persis Benetta
M.Optom 2nd yr

2. INTRODUCTION
•Also called Disc oedema
•Passive disc swelling associated with increased intra cranial pressure
•Bilateral and asymmetrical

3. CAUSES
•Inflammations such as papillitis, neuroretinitis, papillophlebitis and
uveitis.
•Ocular hypotony
•CRVO, AION (anterior ischemic optic neuropathy) and uremia
•Orbital causes – tumors, grave’s orbitopathy and orbital cellulitis
•Leukemia and lymphomas

4. ETIOPATHOGENESIS
•Congenital conditions – aqueductal stenosis, and craniosynostosis
•Intracranial space occupying lesions – brain tumors, tuberculoma,
subdural haematoma, and aneurysms
•ICSOLs of cerebellum, mid brain and parieto occipital region produce
papilloedema
•Intracranial infections – meningitis, encephalitis
•Intracranial hemorrhages
•Obstruction of CSF
•Tumors of spinal cord

5. •idiopathic intracranial pressure
•Systemic condition
•Cerebral oedema
•Cerebral venous sinus thrombosis

6. UNILATERAL VS BILATERAL
•Unilateral – disc swelling due to ocular and orbital lesions
•Bilateral – raised intracranial pressure papilloedema
•Foster Kennedy syndrome – olfactory or sphenoidal meningiomata
and frontal lobe tumors
•Pseudo Foster Kennedy syndrome – unilateral papilloedema
raised intracranial pressure and a pre existing optic atrophy

7. FOSTER KENNEDY SYNDROME
Foster Kennedy syndrome: papilledema in one eye with optic atrophy in
the other eye
Funduscopy in a 36-year-old man with headaches and loss of vision. (A)
Edema of the optic disk (arrows) in the chronic phase (“champagne cork”)
is visible in the right fundus, with venous tortuosity and dilatation
(arrowheads). (B) Left funduscopy shows a pale optic disk, consistent with
axonal death. The lack of colour is more marked in the temporal area

8. PSEUDO FOSTER KENNEDY
SYNDROME
Fundus photograph showing right eye papilledema and left eye optic disc pallor.
Pseudo-Foster Kennedy syndrome in a young woman with meningioma infiltrating the
superior sagittal sinus

9. PATHOGENESIS – HAYREH’S
THEORY

10. CLINICAL FEATURES
General features – headache, nausea, projectile vomiting and
diplopia
Ocular features – VA and pupillary reactions usually remains fairly
normal until the late stage of the disease

11. STAGES OF PAPILLOEDEMA –
EARLY (INCIPIENT)
VA and pupillary reactions usually remains normal
Ophthalmic feature – obscuration of the disc
Blurring of peripapillary nerve fibre layer
Absence of venous pulsation
Mild hyperaemia of the disc
Splinter hemorrhages

13. FULLY DEVELOPED PAPILLOEDEMA
Transient visual obscuration in one or both eyes and pupillary
reactions are normal
Optic disc oedema – forward elevation
Cup of the disc is obliterated
Disc becomes hyperaemic and blurring of the margin is present
Multiple cotton wool spots
Veins becomes tortuous and engorged
Paton’s line
Enlargement of the blind spot

15. CHRONIC PAPILLOEDEMA
VA is reduced and pupillary reactions are normal
Acute hemorrhages and cotton wool spots
Optic disc gives the appearance of the champagne cork
Blind spot enlarges and visual field begins to constrict

17. ATROPHIC PAPILLOEDEMA
Develops after 6-9 months
Severely impaired VA
Light reflex is impaired
Greyish white discoloration and pallor disc
Prominence of the disc decreases
Retinal arterioles becomes narrowed and vein become less
congested
White sheathing develops
Concentric contraction of the visual field

19. VISUAL FIELD

20. TREATMENT AND PROGNOSIS
Neurological emergency
CT scan and MRI
Unless the causative disease is treated or cerebral decompensation
is done, the course of papilloedema is chronic and prognosis is bad