Papilledema is optic nerve swelling to both eyes due to increased fluid pressure within the brain. The increased pressure in the brain can cause headache and nausea. The swelling of the optic nerve may cause progressive vision loss.
The most common cause of Papilledema is Idiopathic Pseudotumor Cerebri (PTC). In this disease, the cause of the elevation of intracranial pressure and secondary optic nerve swelling is unknown.
The majority of patients with Pseudotumor Cerebri are female, overweight, and aged 20-40. Although it is most common in overweight females, it is possible for males, those of normal weight, as well as children to be affected.
Numerous medications including Tetracycline, Minocycline, Nalidixic Acid, Nitrofurantoin, Danazol, Corticosteroids, or birth control pills have been associated with PTC.
Treatment is limited to those with headache or vision loss. Stopping any medication associated with PTC is indicated. Oral diuretics may lower intracranial pressure and lessen the optic nerve damage. Weight reduction will often improve or cause resolution of the disease.
In cases where oral medication or weight loss cannot sufficiently correct the intracranial pressure, surgery is indicated:
Optic Nerve Sheath Fenestration is a surgical procedure in which an opening of the sheath around the optic nerve is created. This lowers the pressure on the nerve itself. This procedure is limited to patients in whom nerve damage is occurring or imminent.
Lumboperitoneal Shunt is a drain connecting the fluid in the brain to the abdomen. This surgical procedure is used for advanced and chronic cases which are not responding to weight loss or oral medications.