Can an Eye Exam Detect Papilledema?

You might know that many systemic conditions can be picked up during a comprehensive eye examination, even if they are not strictly eye diseases. It has been said that the eyes are a window to the body and this is incredibly shown through conditions such as papilledema.

Papilledema is a serious condition because it affects the brain. Read on to learn more about what this condition is, how it is detected, and what it can indicate.

What is Papilledema?

Papilledema is a swelling of the optic disc at the back of the eye due to increased pressure within the cranium, or head. The optic disc is a bundle of nerves that connects the eye to the brain, providing the information needed for vision.

Symptoms of papilledema can be instances of transient vision loss in both eyes, which can be associated with actions such as switching between sitting and standing. Other symptoms include headaches, nausea, double vision, or possibly decreased clarity in vision.

How Is Papilledema Detected?

Papilledema is first suspected by our optometrists when completing a comprehensive eye exam. During the exam, our doctors will assess the back of the eye by using a special lens that magnifies the view through a microscope called the slit lamp.

Photographs can also provide a view of the back of the eye, although in some cases do not allow for a three dimensional view. The doctor will assess for swelling as well as other associated signs that may be present within the eye.

The degree of swelling can be noted through observation through the slit lamp and lens but a more objective way to measure the swelling would be through a scan taken with our OCT, otherwise known as optical coherence tomography. This machine allows for a three dimensional map of the elevation of the optic disc as well as the thickness of the retinal nerve fiber layer at the back of the eye.

Associated signs will also need to be tested for and assessed, such as high blood pressure, abnormalities in other parts of the eye, and neuroimaging. A full physical and systemic examination may be recommended to rule out other systemic conditions.

There are other conditions that can mimic papilledema so it is important for our doctors to test for other associated signs and refer the patient to complete tests that are not available in our office.

What Can Papilledema Indicate?

Papilledema is officially diagnosed when the pressure within the cranium is confirmed to be high. However, a finding of swollen nerves is an indicator to test for conditions that may be causing high cranial pressure, and a swollen nerve without increased intracranial pressure must still be looked into by our doctors.

These underlying conditions can include intracranial tumours (growths that may be cancerous), hematomas, hemorrhages (bleeding), meningitis (infection and inflammation), or brain abscesses. Treatment for these conditions will be required from neurology or neurosurgery.

In some cases, swollen nerves could have no underlying cranial cause and are referred to as idiopathic intracranial hypertension (IIH). This condition can occur in overweight females and is associated with significant weight gain, pregnancy, or certain medications.

Treatment for IIH involves discontinuing the medication that is causing it or lifestyle modifications to decrease weight. Medication can also be used to lower the intracranial pressure.