Papilledema (Swelling of the Optic Nerve)

What is papilledema?

Papilledema is swelling of the optic nerves that occurs because there is increased pressure around the brain.

The optic nerves are connected to the brain. When pressure around the brain is too high, this pressure pushes on the optic nerves and makes them bulge. This bulging can be detected during an eye exam. When the pressure around the brain is too high, it is very important to find out what is causing it as quickly as possible.

What are the symptoms of papilledema?

The symptoms of papilledema are the same as those of high brain pressure. The most common symptom is headaches. The headaches may be worse in the morning or wake the person up from sleep. The headaches may also worsen when a person bends over or strains. They may get more frequent and more severe over time and may also be located in the same part of the head every time. Other common symptoms related to headaches are nausea and vomiting. A person may experience a ringing or whooshing sound in their ears that may sound like a heartbeat. A person may also experience temporary dimming or darkening of their vision, spots in their vision, or even double vision.

What causes papilledema?

Papilledema is caused by high brain pressure, which can be serious. It is important to find out what is causing the pressure as quickly as possible. Some serious causes of high brain pressure include tumors, bleeding, infection, high blood pressure, or blood clots. Other causes of high brain pressure include medications such as oral contraceptives, certain antibiotics, and medicines containing steroids. Increased brain pressure can also occur without a known cause, particularly in young overweight women. 

How is papilledema diagnosed?

Papilledema is first diagnosed by a thorough medical history and physical examination.  A full dilated eye exam allows an eye doctor to look directly at the optic nerves to check for swelling. An eye doctor may also perform other tests to help diagnose papilledema including an ultrasound or a test of the peripheral vision. If papilledema is confirmed, it may be necessary to perform urgent tests in a hospital, including MRI and possibly a spinal tap. 

How is papilledema treated?

The treatment for papilledema depends on the cause. Treatment involves first reducing the pressure around the brain. Your doctor may prescribe medicines or recommend surgery. Weight loss is important for all patients who are overweight.