Papilledema

Papilledema is a condition in which there is increased pressure in or around the brain (intracranial pressure or ICP) that causes swelling of the part of the optic nerve inside the eye known as the optic disc.

Pathogenesis

Surrounding the optic nerve is a normal subarachnoid space as elsewhere in the CNS. Intracranial hypertension caused primarily by a tumor, bleeding, or infection will increase the pressure around the optic nerve (cranial nerve No. II). In addition, the central retinal vein runs in the middle of the optic nerve and after about 8 mm leaves the nerve, crosses the meninges, and is vulnerable. However, it turns out that the main contribution to the swelling of the papilla is the swelling of the axons caused by mechanical pressure in the lamina cribrosa sclerae (impaired orthograde axoplasmic transport).

Clinical findings

• swelling bilateral, initially may be asymmetric
• slightly rounded border of the papilla
• leveled excavation around a rare flame-like hemorrhage
• pupillary reactions are normal
• visual functions are intact for a long time, the first sign is the expansion of the blind spot
• if the cause is not removed, the edema progresses, hemorrhages increase and, in the final stage, severe vision damage occurs, blindness is at risk

Sources

• https://rarediseases.info.nih.gov/diseases/7318/papilledema
• BENEŠ, Jiří. Otázky z očního lékařství [online]. [cit. 2010-11-05]. <http://jirben2.chytrak.cz/>
• ROZSÍVAL, Pavel, et al. Oční lékařství. 1. vydání. Galén, Karolinum, 2006. ISBN 80-7262-404-0.
• KOLÍN, Jan. Oční lékařství. 2. vydání. Karolinum, 2007. ISBN 978-80-246-1325-3.
• STEIN, Joshua D, Denise S KIM a Kevin M MUNDY, et al. The association between glaucomatous and other causes of optic neuropathy and sleep apnea. Am J Ophthalmol [online]. 2011, vol. 152, no. 6, s. 989-998.e3, dostupné také z <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223261/?tool=pubmed>. ISSN 0002-9394 (print), 1879-1891.