Definition
Papilla excavation is the deepening of the so-called optic nerve papilla. The papilla is the point in the eye where the optic nerve enters the eyeball. There is no retina at this point, so this part of the eye is not required for active vision.
However, it is a weak point of the eyeball because there is a gap in all stabilizing layers surrounding the eyeball. Therefore, the tissue at the optic nerve papilla can be quickly affected by changes in the eye. This is especially the case when there is increased pressure in the eye. The pressure in the eye pushes the optic nerve slightly outwards, creating a depression called the optic disc excavation.
The causes
Classically, glaucoma is the most common cause of optic disc excavation. This results in increased pressure in the eye, which can be relieved by pushing the optic nerve papilla slightly outwards at the site of the papilla. Normally, the papilla has a small natural cup.
Only when this cup is particularly pronounced (for example, due to pressure) is it called a pathological optic disc cup. Other diseases can also cause papilla excavation. These include inflammation of the eye, such as uveitis, which is also associated with increased intraocular pressure.
Congenital diseases with optic disc excavation include coloboma (a defect of the iris). Glaucoma, also known as glaucoma, is a disease that is associated with increased intraocular pressure. A distinction is made between an acute glaucoma attack and chronic glaucoma.
In an acute attack, the angle of the chamber (the place where the fluid is filtered out of the eye) can become blocked so that there is a sudden increase in pressure due to too much fluid. The increased pressure inside the eye pushes the optic nerve papilla outwards, causing a papilla excavation. Typical symptoms are visual disturbances and restrictions of the visual field.
Acute glaucoma attacks in particular can cause other symptoms such as eye and headaches as well as reddened eyes and a very hard eyeball. Chronic glaucoma, on the other hand, often has very few symptoms because it progresses only slowly and the body adapts to the changed conditions in the eye. Papilla excavation does not always have to be associated with glaucoma.
There are also other conditions that are associated with increased intraocular pressure, which can cause papilledema. These include inflammatory diseases of the eye, which also lead to an increased accumulation of fluid and cells in the eye, thereby increasing pressure. However, diseases outside the eye can also occasionally cause papilla excavation.
For example, a pull on the optic nerve can lead to a papilla excavation. This is often caused by the brain. Occasionally, a papilla excavation can be present from birth.
This is called a congenital cup. The change in the structure of the optic nerve papilla is not necessarily associated with disease. For example, it may be a slight malformation of the eye that does not result in any symptoms.
The vision does not have to be impaired either. Especially if the papilla excavation does not change and no symptoms occur, it can be assumed to be harmless. Nevertheless, regular controls of the papilla excavation should be performed. Another cause of congenital optic disc excavation is congenital glaucoma, which is associated with increased eye pressure. This is a disease of the eye that should be treated as soon as possible to minimize the visual impairment.