How is papilledema diagnosed?

Papilledema can be diagnosed by the ophthalmologist in a number of different ways. Typically, the first step is to take a medical history, during which the person concerned expresses the corresponding symptoms (visual disturbance, headaches). Then a so-called ophthalmoscopy is performed.

This involves a special ophthalmoscope, which allows a magnified view of the back of the eye (including the retina and papilla). A congestive papilla can be diagnosed in such an examination. Imaging techniques are also suitable for a diagnosis.

For example, an ultrasound of the eyeball can be made. However, sectional imaging procedures such as CT or MRI are also suitable in principle for diagnosing papilledema. Magnetic resonance imaging is a sectional imaging procedure.

In an MRI of the eye, the eye region is examined in particular, so that a three-dimensional image of the eye can be reconstructed afterwards. In this way, even small changes in the eye can be detected. MRI is particularly suitable as an imaging method for the eye, since this examination makes it possible to distinguish between the various soft tissues of the eye. Therefore, an MRI can show whether the papilla of the examined eye is swollen. In addition, a change in consistency can also be detected in the MRI if there is fluid retention.Typically, the pupillary edema in the MRI is shown in a different brightness level than the surrounding tissue.

Unilateral versus bilateral papilledema

Papilledema can basically occur in both eyes at the same time or only in one eye. If papilledema occurs in both eyes, the disease is usually caused by central factors. For example, increased intracranial pressure can lead to a congested papilla.

This causes increased pressure within the skull due to various diseases. This pressure can only escape in a few places due to the hard skull bone. A typical place for this is the papillae in the eye, where the entrance of the optic nerve is literally pressed into the eye socket by the pressure in the skull.

Depending on the level of intracranial pressure, papilledema can therefore be stronger or weaker. Possible reasons for an increased intracranial pressure that causes bilateral pupillary edema are trauma to the skull, brain tumors or even inflammation of the brain and/or meninges. If, on the other hand, there is only unilateral pupil edema, the blood flow to the affected side is usually disturbed.

This can have many different reasons. For example, diseases such as high blood pressure, diabetes mellitus (blood sugar disease) or inflammatory changes in the vessels (such as temporal arteritis) are possible causes of disturbed blood circulation. As a result, pupillary edema can be triggered.

Typically, the symptoms of these underlying diseases initially occur in only one eye. Mostly, however, the second eye is also affected a little later, since the vessels in both eyes are affected by these underlying diseases. However, a consistent therapy of the risk factors (diabetes therapy, lowering of blood pressure, etc.) can prevent a disease of the second eye and alleviate the complaints of the affected eye.