PAPILLOEDEMA IN OCULAR MANAGEMENT PPT NOTES

Welcome

1. PAPILLOEDEMA BY group 2 Presenter : Jackline mugambi

2. Outline Introduction Aetiology Clinical presentation Investigations Treatment Complications

3. Introduction Def:refers to the passive disc swelling associated with increased ICP Almost always bilateral though it can be assymetrical Disc oedema or disc swelling includes all causes of active or passive oedematous swelling of the optic disc other than the causes of papilloedema

4. Aetiology Inflammations e.g papillitis,neuroretinitis,uveitis & papillophlebitis Ocular hypotony Vascular causes e.g CRVO, AION ,uremia & diabetic pappilopathy Orbital causes e.g tumours,TED , orbital cellulitis Infiltrative conditions e.g leukemias & lymphomas

5. pathogenesis Some of the conditions associated with papilloedema include; Congenital conditions e.g aqueductal stenosis & craniosynostosis Intracranial SOLs e.g brain tumours,abcesses,aneurysms,subdural hematomas.these obstruct the aqueduct of sylvius Intracranial infections e.g meningitis and encephalitis Intracranial haemorrhages i.e cerebral and subarachnoid haemorrhages

6. Pathogenesis cont … Impaired /obstructed CSF absorption e.g due to damaged arachnoid villi Spinal cord tumours Idiopathic intracranial HTN also known as pseudotumour cerebri Sytemic conditions e.g malignant HTN,pregnancy - induced HTN,nephritis Diffuse cerebral oedema -from blunt head trauma Cerebral venous sinus thrombosis

7. UNILATERAL VS BILATERAL PAPILLOEDEMA Ocular and orbital lesions usually cause unilateral papiloedema Majority of cases with raised ICPs have bilateral disc swelling Other conditions present with unilateral disc swelling with unequal disc changes Some of the conditions presenting with such include; Foster-Kennedy syndrome Pseudo-foster kennedy syndrome These are better explained by the Hayre’s Theory

8. Evolution and recovery of papilloedema Usually develops quickly-appearing within 1-5 days of raised ICP Develops more rapidly in subarchnoid haemorrhage (2-8 hrs ) However,recovery from fully developed papilloedema is rather slow Takes about 6-8 weeks to subside after ICPs have normalised

9. Clinical features GENERAL General features of raised ICPS e.g headache,projectile vomiting,nausea and diplopia Focal neurological deficits may be present OCULAR Hx of recurrent transient blackout vision ( amaurosis fugax ) VA remains fairly normal Pupillary reaction remains fairly normal

10. Staging of c/features of papilloedema 1.EARLY (Incipient) papilloedema Symptoms are usually absent and VA is normal Pupillary reactions are normal Ophthalmoscopic features Obscuration of the disc margins ( nasal,superior,inferior &temporal) Blurring of the peripheral nerve layer Absence of spontaneous venous pulsation at the disc(in 80% of normal individuals) Mild hyparaemia of the disc Splinter haemorrhages in the peripapillary region may be present Visual fields are fairly normal

11. 2.Established (fully developed ) papilloedema Symptoms Hx /o transient visual obscurations in one or both eyes-lasting afew seconds after standing VA is usually normal Pupillary reaction remains fairly normal Ophthalmoscopic features Apparent optic disc oedema -seen as its elevation above the retinal plain(1-2mm, 1mm is equivalent to +3 diopters) Physiological cup of the disc is obliterated Multiple cotton wool spots & superficial haemorrhages may be seen near the disc

12. Stage 2 cont….ve Veins become tortous and engorged ( mushroom or dome shaped) The disc appears enlarged and elevated so that vessels bend sharply over its margins Patton’s lines i.e circumferential greyish white folds-due to separation of nerve fibres by the oedema Hard exudates- rare.may radiate from the fovea in form of an incomplete star (macular star/fan) Visual fields:shows enlargement of blind spot

13. 3.chronic/longstanding (vintage) papilloedema VA is variably reduced depending on the duration of the papilloedema Pupillary reaction-usually normal Ophthalmologic features Acute haemorrhages and cotton wool spots resolves.. peripapillary edema is resorbed The optic disc gives appearance of the dome of a champagne cork Visual fields : blind spot is enlarged and the visual fields begin to constrict

14. Atrophic papilloedema Symptoms Develops after 6-9 months of chronic papilloedema Characterised by severely impaired VA Pupillary reaction:Light reflex is impaired ophthalmic features Greyish white discoloration and pallor of the disc pallor due to atrophy of the neurons and associated gliosis Disc prominence decreases in cases of persistent ICPS Congested retinal arterioles and less congested veins Visual fields:concentric contraction of peripheral fields become apparent as atrophy sets in

15. Diffrential dxs Pseudopapilloedema Papillitis

16. investigations CT Scan MRI with gadolinium enhancement

17. treatment Hospitalisation Cerebral decompression Ultimate visual prognosis is bad