Papilloedema

Definition

The papilla is the point in the eye where the optic nerve enters the eye. At this point, fluid can accumulate, which is called oedema. A papilledema is therefore an accumulation of fluid in the optic nerve papilla.

In most cases, this “congestion papilla” occurs due to increased pressure in the head. As a result, the visual performance deteriorates. Typically, papilledema can be recognized in the examination of the eye by a swelling or protrusion of the papilla.

What are the causes?

Papilloedema can be caused by a variety of factors. Most often, there are problems in the blood circulation, which leads to a build-up of fluid in the papilla of the eye. Depending on whether only one eye or both sides are affected, conclusions can be drawn about the different causes.

If papilledema occurs simultaneously on both sides, it is usually a so-called central cause, which has its origin in the skull (usually the brain). For example, increased intracranial pressure can lead to a congestion papilla. However, inflammations in the brain (meningitis, encephalitis) or brain tumors can also increase the pressure in the skull and thus cause a congestion papilla in both eyes.

In contrast, circulatory disorders such as central artery occlusion or central vein occlusion can also cause unilateral papilledema. Arteritis temporalis (now officially called giant cell arteritis) is an inflammatory disease of the temporal artery. Inflammatory cells accumulate in the temporal artery.

These can disrupt the blood flow in the temporal artery and thus also disrupt the blood supply to the eye. As a result, the blood flow in the affected eye is reduced. Due to the altered blood flow situation, a congestion papilla (papilloedema) can develop.

In addition, severe visual disturbances can occur. Arteritis temporalis should be treated as soon as possible, since a prolonged poor blood circulation in the eye can lead to permanent visual damage. The central arteries are vessels that supply the retina of the eye.

Since the eye itself is a closed area, the vessels of the eye as well as the optic nerve at the papilla must be able to enter and leave the eye. Papillary edema usually causes the optic nerve papilla to bulge. This not only affects vision, but also worsens the blood supply to the vessels that enter the eye at the papilla.

Thus, papilledema can disturb the blood flow to the retina. Furthermore, the flow conditions in a vessel that is compressed due to papilledema change. A small blood clot (thrombus) can quickly form at the affected site, which then completely occludes the artery (central artery occlusion). As a result, the retina of the affected eye is no longer sufficiently supplied with blood, resulting in damage to the retina and (sometimes irreversible) visual impairment.