Anna Barbara Kłysik MD,

DRCOphth

PAPILLOEDEMA, PAPILLITIS

& PSEUDOPAPILLITS

Definition of Papilloedema;

BILATERAL
swelling of the optic nerve head

causeb by INCREASED INTRACRANIAL

PRESSURE (ICP)

MAY BE ASYMMETRICAL

 

Definition of Papillitis;



Unilateral or bilateral optic disc swelling
from inflammatory or infectious local
causes.

INFLAMMATION OF THE OPTIC NERVE

HEAD

Causes of Papillitis;



Posterior Uveitis



Toxoplasmosis



CMV retinitis



Thyroid ophthalmopathy etc.



Leukaemia



Anaemna



Policythemia



Macroglobulinaemia

Definition of Pseudopapillitis;



Congenital or developmental
abnormality that mimics
papilloedema/ papillitis on clinical
appearance.

Pseudopapillitis;



Optic disk drusen



Hypermetropia



Low intraocular pressure

(postraumatic, postsurgical or

developmental abnormality)

Pathophysiology of Papilloedema;



Decreased axoplasmic flow in neurits of

the optic nerve causes swelling of the pre-

laminar part



Impaired blood circulation of the optic

nerve head

Causes of increased

intracranial pressure;



Hydrocephalus



Brain Tumor



Meningitis or encephalitis



Brain abscess



Essential (Primary Increased intracranial

pressure)



Intracranial haemorrhage (intracerebral,

subarachnoid etc.)



Cavernous sinus thrombosis



Facial dysistosis



VASCULAR



INFLAMMATORY



INFECTIOUS



METABOLIC



TRAUMATIC



NEOPLASTIC



CONGENITAL / DEVELOPMENTAL



IDIOPATHIC



IATROGENIC

CAUSES OF ANYTHING

;

Causes of increased intracranial

pressure



neolpastic : tumors; glioma, meningioma



Vascular; intracranial bleeding, aneursm



idiopathic : essential intracranial hypertension



infectious : meningitis, encephalitis



Toxic : lead poisonig

chronic vitamin A overdose



metabolic: kidney failure

hiperkapnia, respiratory insuficiency



developmental: Hydrocephalus

dysostoses
Arterio-venous malformations



jatrogenne: brain surgery

tetracyclines



Traumatic; Brain concussion

Symptoms

of increased intracranial pressure :



headache



nusea and vomiting



epileptic fits



general malaise,
fatigue



photopsiae



Smell abnormalities

Signs

of increased intracranial

pressure

- Papilloedema

- VI Nerve Palsy (false localizing sign)
- High BP
- Low Hart Rate
- breathing problems ( end stage; from bulbar
compression)
- impaired pupill reaction to light ( uncal herniation)



Papilloedema is the only
sufficient sign to make the
diagnosis of increased
intracranial pressure



In BRAIN TUMORS development of papilloedema depends

on the type of tumor, localization and the speed of growth

Rapidly growing tumors give papilloedema more often than

slow growing tumors.



In SUBARACHNOID HAEMORRHAGE papilloedema may

develop raidly, over several hours.



If OPTIC ATROPHY preceeds increased intracranial

pressure, papilloedema will NOT develop.

PAPILLOEDEMA IN BRAIN TUMORS;



Frequency depends on age:



Most common in children and young adults.



50 % occours below the age of 20.



20 % occours between age 20 and 40



really very rarely above 70.



More commonly in posterior fossa tumors than in frontal
tumors.

 

Stages of Papilloedema



Clinical appearance of Papilloedema depends on

how high is the intracranial pressure and how

long it has been going on for.



Stages;

- early
- full blown
- chronic
- optic atrophy

Early Papilloedema:



Blurry nasal margin of the
optic nerve head



Leak on Fluorescein
Angiography.



Dilated veins on the optic
nerve head

lack of venous pulsation
( also in 20% of normal

individuals)



Papillary splinter
haemarrhage



Visual acuity is usually
normal at this stage

Early Papilloedema

Early Papilloedema

-differential diagnosis



Optic disk drusen



Hypermetropia



Hypertensive retinopathy



Small optic disk



Myelinated nerve fibres



Congenital optic nerve head
abnormalities

Full blown papilloedema;



Elevated disc, mashroom shape, loss of sharp borders



Wide tortuous disc vessels, flame haemorrhages,cotton
wool spots, hard exudates



Peripapillary retinal folds ( Paton’s folds)



Visual acuity normal or decreased, impaired colour
perception.

 

 



Diabetic and hypertensive retinopathy;

Differential diagnosis of fullblown

Papilloedema rerly causes problems.

Chronic Papilloedema;



Mashroom shape elevation.



Haemorrhages are diminishing



Drusen-like deposits on the disc



Sometimes macular star



Decreased visual acuity

 

Late; Optic nerve atrophy;



Grey or white optic nerve head with blurry margins, slightly
elevated.



Peripapillary pigmentary changes



VA; no light perception or light perception

 

Foster-Kenedy’s Syndrome:

    



Optic atropyh on the side of the tumor and
papilloedema on the contralatelal side.



May be caused by frontal tumor.



Differential diagnosis; new AION on one side and
optic atrophy from old AION on the contralateral
side.

Thank you for your attention.



QUESTIONS?



What is the definition of
Papilloedema?



What are the causes of
Papilloedema?



What are the causes of papilltis?



What are the causes of
pseudopapillitis.