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Emergency: requires immediate attention
Papilledema - External and Internal Eye
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Emergency: requires immediate attention

Papilledema - External and Internal Eye

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Contributors: Rachel Ellis MD, Andrew Goodfriend MD, Brandon D. Ayres MD, Christopher Rapuano MD, Harvey A. Brown MD, Sunir J. Garg MD, Lauren Patty Daskivich MD, MSHS
Other Resources UpToDate PubMed

Synopsis

Papilledema refers to increased intracranial pressure causing swelling to both optic nerves that is visible on ophthalmic examination.

Papilledema can lead to blindness, but perhaps even more importantly, it can be the first sign of a mass in the brain. Disorders that can cause papilledema include intracranial masses, cerebritis or meningitis, subarachnoid or subdural hemorrhage, and pseudotumor cerebri (idiopathic intracranial hypertension).

The optic nerve appears swollen in both eyes, though in the early stages it may be asymmetric. Patients may notice blurred vision that may come and go. With chronic papilledema, there can be progressive visual field loss with eventual loss of central acuity. In chronic papilledema, the nerve may be atrophic with attenuated blood vessels and not show signs of swelling. Other signs or symptoms of elevated intracranial pressure such as headache, nausea, vomiting, diplopia, ataxia, or altered consciousness may occur as well.

Codes

ICD10CM:
H47.10 – Unspecified papilledema

SNOMEDCT:
423341008 – Optic disc edema

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Disc edema due to causes other than increased intracranial hypertension 
  • Optic disc drusen (often causing a condition known as pseudopapilledema) 
  • Papillitis 
  • Optic neuritis 
  • Optic nerve tumors 
  • Leber's optic neuropathy 
  • Ischemic optic neuropathy (see anterior ischemic optic neuropathy
  • Optic disc infiltration (ie, sarcoid or metastasis) 
  • Malignant hypertension 

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 01/28/2013
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Emergency: requires immediate attention
Papilledema - External and Internal Eye
Print 11 Images
View all Images (11)
(with subscription)
Papilledema : Blurred vision, Headache, Nausea/vomiting, Diplopia, Optic disc edema, Tinnitus, Visual field defect
Clinical image of Papilledema
Copyright © 2019 VisualDx®. All rights reserved.