Do you feel this difference in your eyes? Let's talk about Papilledema!

Do you sometimes get headaches , feel like you suddenly lose your vision in both eyes? Or do you sometimes see things in two? If you have these symptoms, it could be a sign of a condition called papilledema. Don't worry, let's talk about it simply.

What is Papilledema?

Simply put, papilledema is a swelling of the optic disc in both of your eyes . This is caused by increased intracranial pressure . Imagine, there is a watery fluid around our brain and down the spinal cord. We call this Cerebrospinal Fluid (CSF) . This fluid is constantly being produced and reabsorbed by the body. This is what protects our brain from being bounced around and from minor accidents. It's like the `shock absorbers` in a car. Now, if this `CSF` fluid doesn't get absorbed properly and accumulates, or if it builds up inside the brain for some other reason, the pressure inside the skull gradually increases. This increased pressure causes the optic nerve , which connects the eye and the brain, to become compressed and its root, the optic disc, to swell. The optic disc is where the optic nerve enters the eye. Usually, when the pressure inside the skull increases , bilateral papilledema occurs. This means that the optic nerve roots in both eyes swell. However, if the optic nerve root in only one eye (unilateral) swells, we call it `optic disc edema` . This is usually due to increased pressure inside the skull. The most important thing is that this condition called papilledema can be considered a medical emergency . Because increased pressure inside the skull is a serious matter that can sometimes be life-threatening.

Who is most affected by this papilloedema condition?

This condition, called papilloedema , is more common in women. It is especially common in women between the ages of 20 and 44 who have a body mass index (BMI) of 25 or more, which is slightly overweight, or a BMI of 30 or more, which is obese . It has been found that about 13 out of every 100,000 people in that group may develop this condition. However, in a country like the United States, this condition is not that common. It is reported in less than one out of every 100,000 people (0.9) of the total population. So, it is not a disease that affects everyone, but it is something that should be taken into account no matter who develops it.

What are the symptoms of this papilloedema condition?

Sometimes you may not have any symptoms (asymptomatic).Papilledema can occur. However, there are several common symptoms that can be seen:

• Headache: This is the main symptom. The headache that comes with papilledema is most felt when you first get up in the morning or when you lie down . It can feel like your head is being squeezed from the inside.
• Transient visual obscurations: This is a very specific symptom. Suddenly , for a short period of time, such as 5 to 15 seconds, either one eye (unilateral) or both eyes (bilateral) become blurred, gray, or black . This is similar to the moon covering the sun during a solar eclipse. This most often happens when you change positions, for example, when you stand up or sit down.
• Double vision (Diplopia): Increased pressure inside the skull can sometimes affect the nerves that control the muscles that move the eyes (cranial nerve palsy) . This is when one thing appears to be two.
• Nausea and vomiting: These symptoms may occur along with a headache.
• Other neurological symptoms : Some people may also experience difficulty walking and changes in thinking.

Remember, if this condition is not treated properly, vision can gradually deteriorate over time.

Imagine, there is a young woman named Nimali. She is a bit overweight. For several months, she has been getting a severe headache when she wakes up in the morning. Sometimes, as soon as she wakes up, her vision goes black for a few seconds. She thought it was just fatigue. But one day, she suddenly started seeing things in two ways. That's when she got scared and went to see a doctor. It was only when the doctor examined her eyes that he discovered that she had papilloedema.

What causes papilloedema?

As we've discussed before, papilledema is caused by increased pressure inside the skull . So, there are several reasons why this pressure can increase:

• Malignant hypertension : If you have uncontrollable high blood pressure , it could be a cause of this.
• Tumors: Certain types of tumors that develop in or around the brain can cause increased pressure.
• Infection, bleeding, or swelling/inflammation of the brain and meninges: If there is an infection, bleeding, or inflammation of the brain or the membranes that cover the brain and spinal cord (meninges), that can also cause increased pressure.
• Cerebral venous sinus thrombosis:If a blood clot forms in a large blood vessel (vein) in the brain, it can also obstruct the flow of CSF fluid, causing pressure to increase.
• Iron-deficiency anemia: This has also been found to be sometimes associated.
• Certain medications: The use of certain medications can also affect this. For example, Retin-A and retinoids (vitamin A-related medications), excessive vitamin A intake, tetracycline antibiotics, COVID-19 infection, and corticosteroids (steroid medications) have also been reported to be associated with this.
• Idiopathic Intracranial Hypertension (IIH): Sometimes the pressure inside the skull is increased, but no clear cause can be found. The word ``idiopathic`` means ``of no known cause.`` This ``IIH`` condition is especially common in young, obese women.

Is papilloedema hereditary?

No, papilloedema is not a hereditary disease .

Does migraine cause papilledema?

No, papilledema does not occur due to migraine. However, someone with papilledema may experience headaches that can be similar to migraine headaches. So it is important to find out exactly what it is.

How do you accurately diagnose papilledema?

If you have symptoms such as headaches and vision changes, you may be diagnosed with papilledema when you see a doctor. Your eye doctor will first examine your eyes. He or she may do special tests, such as visual field testing . He or she may then look for swelling in your optic disc. If the optic disc appears swollen, you will be referred for an imaging examination . This is often an MRI (Magnetic Resonance Imaging) scan . This can look for tumors or bleeding in the brain. Sometimes your doctor may also order a lumbar puncture (spinal tap) . This can check for pressure inside the skull and for infections in the cerebrospinal fluid (CSF). In addition, blood tests may be done to check for things like iron levels.

How is the severity of papilledema measured?

Doctors use a method called the Frisén scale to measure the severity of papilledema. It has several stages.

• Grade 0: The optic nerve root is normal, but the edges may appear slightly blurred.
• In higher stages like Grade V:The entire optic nerve root is swollen and bulging. The swelling is so severe that the blood vessels on and coming out of the nerve root are not clearly visible.

Simply put, these stages indicate how severe the swelling is.

How is papilloedema treated?

The treatment for papilledema depends on the cause .

• If papilledema is caused by unexplained increased intracranial pressure (IIH):
• Your doctor may prescribe a carbonic anhydrase inhibitor, such as acetazolamide . This medicine helps reduce the production of CSF fluid and lowers the pressure.
• It also helps you maintain a healthy weight . This is a long-term solution.
• If these methods fail to reduce the pressure, doctors may suggest surgical procedures to reduce the pressure inside the skull. For example, a shunt is a tube that allows the cerebrospinal fluid (CSF) to drain to another location.

• If papilloedema occurs for another reason:
• The doctor will treat the underlying cause . For example, a brain tumor will be treated, high blood pressure will be controlled, and an infection will be treated with medication.

The most important thing is to treat papilledema quickly, because if left untreated, it can lead to complete loss of vision in one or both eyes (blindness).

Can the risk of developing papilloedema be reduced?

Yes, you can reduce the risk of developing papilloedema by taking care of certain things:

• Control your blood pressure (especially to prevent dangerously high blood pressure - `malignant hypertension`).
• Maintain a healthy body weight . Obesity can be one of the causes of this, so it is important to control your weight.

Also, regular eye exams are very important . As with any disease, early diagnosis is the best outcome .

What happens if I have papilloedema?

If you and your doctor recognize this condition early, the outcome is usually good . Your doctor will focus on treating the underlying problem. But remember, it is important to treat papilledema because, in addition to the potential for vision loss, it can also cause other neurological effects.

When should I see a doctor about papilloedema and its possible causes?

If you have a new headache that is getting worse, and you are also experiencing nausea and vomiting , you should seek immediate medical care . Also, if you notice any changes in your vision,If there is, definitely show it to a doctor and have it checked.

What is the difference between Papilledema and Pseudopapilledema?

Pseudopapilledema is a "false" form of papilledema . This also causes the optic disc to appear bulging. However, it is not caused by swelling of the optic nerve. Some people may be born with a slightly bulging optic disc, or it may appear to be caused by other conditions, such as optic disc drusen (calcium-like deposits in the optic disc). Because the causes of papilledema can be serious, it is important to see a doctor as soon as possible if you have vision changes, especially if they are accompanied by headaches, nausea, or vomiting.

So, what are the things we should remember from this story? (Take-Home Message)

Okay, I hope you now have a better understanding of what we've been talking about with Papilledema. Let's recap the most important things:

• Papilledema is swelling of the optic nerve roots of both eyes due to increased pressure inside the skull .
• Symptoms such as severe headaches (especially in the morning), temporary blurred vision, double vision, nausea, and vomiting may be suspected.
• This can be caused by a variety of factors, including brain tumors, high blood pressure, infections, certain medications, and idiopathic hypertension (IIH) .
• If the disease is diagnosed early and the cause is treated properly, vision can be preserved. If treatment is delayed, vision can be completely lost .
• If you have these symptoms, don't waste time and see a doctor .
• Maintaining a healthy weight and controlling blood pressure can help reduce the risk of this condition.

Your eyes are very precious, so take care of them. If you notice anything unusual, don't ignore it. It's wise to seek medical advice immediately.