3. PAPILLOEDEMA Neuro Ophthalmology0.ppt

For every student,who study ophthalmology.

1. PAPILLOEDEMA
Prof .Than Aung

2. Definitions
OD oedema,“Disc swelling”,“Choked disc”:
general non specific terms used to describe disc
swelling due to causes other than raised ICP
Papilloedema: OD oedema due to raised ICP
being transmitted to the optic nerves by the CSF
in the subarachnoid space

3. Pathophysiology
Axons of the GC that form the ON
are dependent on metabolic
production within the cell bodies
Axonal transport of metabolic
products occur along the length of
the ON –between the cell body
and terminal synapse
Orthograde (cell body to LGN):
-slow component (1 to4 mm/day )
-fast component ( 400 mm/day )
Retrograde (LGN to cell body) –
(200 mm/day)

4. Pathophysiology
Orthograde transport (less in retrograde)
requires high oxygen energised by ATP and is
sensitive to ischaemic, inflammatory and
compressive processes
In papilloedema, increased perineural
pressure results in interruption of the
axoplasmic tranport
Accumulation of axoplasmic flow at the
lamina cribrosa produces disc swelling
Secondary associated phenomena –dilated
retinal veins, haemorrhages, cotton wool
spots

5. CLINICAL FEATURES
Early papilloedema
No visual symptoms & normal VA
Disc hyperaemia & mild elevation
Blurred disc margins (initially
nasal) due to early swelling of the
peripapillary RNF
Loss of previous spontaneous
venous pulsation (seen in 20% of
normal); its presence renders
diagnosis of papilloedema unlikely

6. Established papilloedema
Transient visual obscurations,
lasting few seconds,
precipitated by change of
posture
VA depends on macular
changes
OD –severe hyperaemia due
to dilatation & telangiectasia of
disc surface capillaries which
leak fluorescene; moderate
elevation & blurred margins
Absence of optic cup –usually
late finding

7. Venous engorgement,
parapapillary splinter
haemorrhages and cotton
wool spots
Oedematous & thickened
peripapillary NFL obscures
the retinal vessels and disc
margins
Circumferencial retinal
folds(Paton’s lines) and
Macular fan
Enlarged blind spot

8. Chronic (Vintage) Papilloedema
VA variable, VF shows arcuate
field defects or peripheral field
constriction
OD –marked elevation
(“champagne cork” appearance )
CWS and haemorrhages
disappear
Opticociliary shunt vessels
Refractile deposits(corpora
amylacea) on the disc surface,
non calcified; disappear as
papilloedema resolves

9. Atrophic Papilloedema
VA severely impaired
OD –grayish colour,
slightly elevated, blurred
margins & few crossing
vessels; gliosis tend to
follow retinal vessels,
producing vascular
sheathing

10. DIAGNOSIS
Diagnosis constitutes a medical emergency
CT or MRI to rule out an intracranial mass lesion
MRV to exclude cerebral venous sinus
thrombosis
Normal imaging –CSF opening pressure and
composition; neurologic consultation