Optic Disc Edema
What causes papilledema?
Cerebrospinal fluid (CSF) surrounds the brain and optic nerve, helping keep them stable and protecting them from any damage that results from sudden movements.
Papilledema occurs when there is increased pressure on the optic nerve from the brain and CSF. This pressure causes the nerve to swell as it enters the eyeball at the optic disc.
There are some serious medical conditions that can cause this increased pressure to develop, including Trusted Source:
- head trauma
- inflammation of the brain or surrounding tissue
- severely high blood pressure, which doctors call a hypertensive crisis
- infection in the brain
- brain tumor
- bleeding in the brain
- blockages of blood or CSF in the brain
- abnormalities of the skull
- idiopathic intracranial hypertension (IIH)
- spinal cord lesions
IIH describes a rare condition Trusted Source in which the body produces too much CSF or does not drain it properly. This excess CSF leads to increased pressure in the brain. The symptoms of IIH usually include headaches, visual disturbances, and ringing in the ears.
The exact cause of this condition is still unclear and appears to be unrelated to any brain disease or injury.
IIH typically affects young females with obesity. Certain medications, such as lithium, antibiotics, and corticosteroids, are also possible causes.
The treatment options for papilledema will depend on the cause of this condition.
In the case of IIH, common treatments include weight loss, a low salt diet, and medications, such as acetazolamide, furosemide, or topiramate.
Surgery — in the form of shunting the excess fluid or making cuts into the optic nerve sheath — is usually only an option when lifestyle changes and medications are not working.
Tumors, head injury, or infection
Certain underlying conditions will require more intensive treatment. For example, a brain tumor, bleeding within the brain, or a blood clot may require surgery. The recommended types of surgical procedures will depend on the conditions that need addressing.
Doctors may treat infections with antibiotics or antiviral medications.
High blood pressure
In rare cases, papilledema can be due to extremely high blood pressure, which doctors refer to as a hypertensive crisis. In these cases, it is essential to reduce blood pressure to avoid more serious harm, so emergency medical care will be necessary. A person will need to receive medical treatment in the emergency room and intensive care unit.
A wide variety of other medical problems and conditions can lead to increased pressure inside the brain.
Brain and eye specialists can determine the best treatment options based on the diagnosis.
Optic neuritis usually affects one eye. Symptoms might include:
- Pain. Most people who develop optic neuritis have eye pain that’s worsened by eye movement. Sometimes the pain feels like a dull ache behind the eye.
- Vision loss in one eye. Most people have at least some temporary reduction in vision, but the extent of loss varies. Noticeable vision loss usually develops over hours or days and improves over several weeks to months. Vision loss is permanent in some people.
- Visual field loss. Side vision loss can occur in any pattern, such as central vision loss or peripheral vision loss.
- Loss of color vision. Optic neuritis often affects color perception. You might notice that colors appear less vivid than normal.
- Flashing lights. Some people with optic neuritis report seeing flashing or flickering lights with eye movements.
When to see a doctor
Eye conditions can be serious. Some can lead to permanent vision loss, and some are associated with other serious medical problems. Contact your doctor if:
- You develop new symptoms, such as eye pain or a change in your vision.
- Your symptoms worsen or don’t improve with treatment.
- You have unusual symptoms, including vision loss in both eyes, double vision, and numbness or weakness in one or more limbs, which can indicate a neurological disorder.
The exact cause of optic neuritis is unknown. It’s believed to develop when the immune system mistakenly targets the substance covering your optic nerve, resulting in inflammation and damage to the myelin.
Normally, the myelin helps electrical impulses travel quickly from the eye to the brain, where they’re converted into visual information. Optic neuritis disrupts this process, affecting vision.
The following autoimmune conditions often are associated with optic neuritis:
Multiple sclerosis. Multiple sclerosis is a disease in which your autoimmune system attacks the myelin sheath covering nerve fibers in your brain. In people with optic neuritis, the risk of developing multiple sclerosis after one episode of optic neuritis is about 50% over a lifetime.
Your risk of developing multiple sclerosis after optic neuritis increases further if an MRI scan shows lesions on your brain.
- Neuromyelitis optica. In this condition, inflammation affects the optic nerve and spinal cord. Neuromyelitis optica has similarities to multiple sclerosis, but neuromyelitis optica doesn’t cause damage to the nerves in the brain as often as multiple sclerosis does. Still, neuromyelitis optica is more severe than MS, often resulting in a diminished recovery after an attack compared with MS.
- Myelin oligodendrocyte glycoprotein (MOG) antibody disorder. This condition can cause inflammation to the optic nerve, spinal cord or brain. Similar to MS and neuromyelitis optica, recurrent attacks of inflammation can occur. Recovery from MOG attacks is usually better than recovery from neuromyelitis optica.
When symptoms of optic neuritis are more complex, other associated causes need to be considered, including:
- Infections. Bacterial infections, including Lyme disease, cat-scratch fever and syphilis, or viruses, such as measles, mumps and herpes, can cause optic neuritis.
- Other diseases. Diseases such as sarcoidosis, Behcet’s disease and lupus can cause recurrent optic neuritis.
- Drugs and toxins. Some drugs and toxins have been associated with the development of optic neuritis. Ethambutol, used to treat tuberculosis, and methanol, a common ingredient in antifreeze, paints and solvents, are associated with optic neuritis.
Risk factors for developing optic neuritis include:
- Age. Optic neuritis most often affects adults ages 20 to 40.
- Sex. Women are much more likely to develop optic neuritis than men are.
- Race. Optic neuritis occurs more often in white people.
- Genetic mutations. Certain genetic mutations might increase your risk of developing optic neuritis or multiple sclerosis
Every nerve in your peripheral system has a specific function, so symptoms depend on the type of nerves affected. Nerves are classified into:
- Sensory nerves that receive sensation, such as temperature, pain, vibration or touch, from the skin
- Motor nerves that control muscle movement
- Autonomic nerves that control functions such as blood pressure, perspiration, heart rate, digestion and bladder function
Signs and symptoms of peripheral neuropathy might include:
- Gradual onset of numbness, prickling or tingling in your feet or hands, which can spread upward into your legs and arms
- Sharp, jabbing, throbbing or burning pain
- Extreme sensitivity to touch
- Pain during activities that shouldn’t cause pain, such as pain in your feet when putting weight on them or when they’re under a blanket
- Lack of coordination and falling
- Muscle weakness
- Feeling as if you’re wearing gloves or socks when you’re not
- Paralysis if motor nerves are affected
If autonomic nerves are affected, signs and symptoms might include:
- Heat intolerance
- Excessive sweating or not being able to sweat
- Bowel, bladder or digestive problems
- Drops in blood pressure, causing dizziness or lightheadedness
Peripheral neuropathy can affect one nerve (mononeuropathy), two or more nerves in different areas (multiple mononeuropathy), or many nerves (polyneuropathy). Carpal tunnel syndrome is an example of mononeuropathy. Most people with peripheral neuropathy have polyneuropathy.
When to see a doctor
Seek medical care right away if you notice unusual tingling, weakness or pain in your hands or feet. Early diagnosis and treatment offer the best chance for controlling your symptoms and preventing further damage to your peripheral nerves.
Peripheral neuropathy is nerve damage caused by a number of different conditions. Health conditions that can cause peripheral neuropathy include:
- Autoimmune diseases. These include Sjogren’s syndrome, lupus, rheumatoid arthritis, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy and vasculitis.
- Diabetes. This is the most common cause. Among people with diabetes, more than halfwill develop some type of neuropathy.
- Infections. These include certain viral or bacterial infections, including Lyme disease, shingles, Epstein-Barr virus, hepatitis B and C, leprosy, diphtheria, and HIV.
- Inherited disorders. Disorders such as Charcot-Marie-Tooth disease are hereditary types of neuropathy.
- Tumors. Growths, cancerous (malignant) and noncancerous (benign), can develop on the nerves or press on nerves. Also, polyneuropathy can arise as a result of some cancers related to the body’s immune response. These are a form of a degenerative disorder called paraneoplastic syndrome.
- Bone marrow disorders. These include an abnormal protein in the blood (monoclonal gammopathies), a form of bone cancer (myeloma), lymphoma and the rare disease amyloidosis.
- Other diseases. These include kidney disease, liver disease, connective tissue disorders and an underactive thyroid (hypothyroidism).
Other causes of neuropathies include:
- Alcoholism. Poor dietary choices made by people with alcoholism can lead to vitamin deficiencies.
- Exposure to poisons. Toxic substances include industrial chemicals and heavy metals such as lead and mercury.
- Medications. Certain medications, especially those used to treat cancer (chemotherapy), can cause peripheral neuropathy.
- Injury or pressure on the nerve. Injuries, such as from motor vehicle accidents, falls or sports injuries, can sever or damage peripheral nerves. Nerve pressure can result from having a cast or using crutches or repeating a motion such as typing many times.
- Vitamin deficiencies. B vitamins — including B-1, B-6 and B-12 — vitamin E and niacin are crucial to nerve health.
Peripheral neuropathy risk factors include:
- Diabetes, especially if your sugar levels are poorly controlled
- Alcohol misuse
- Vitamin deficiencies, particularly B vitamins
- Infections, such as Lyme disease, shingles, Epstein-Barr virus, hepatitis B and C, and HIV
- Autoimmune diseases, such as rheumatoid arthritis and lupus, in which your immune system attacks your own tissues
- Kidney, liver or thyroid disorders
- Exposure to toxins
- Repetitive motion, such as those performed for certain jobs
- Family history of neuropathy.