A 30-year-old woman presents with new onset headaches and blurry vision
What is your diagnosis?
The diagnosis is...
The image is consistent with optic disc edema. When this is due to increased intracranial pressure, it is called papilledema.
- Papilledema occurs when increased intracranial pressure (from any etiology) leads to optic nerve swelling.
- This can be idiopathic, due to intracranial masses or changes in cerebral spinal fluid (CSF) volume balance.
- Papilledema is usually bilateral, and swelling can be identified on fundoscopic examination.
What is the role of the primary care or emergency medicine physician?
- Perform a careful history and physical examination: evaluate risk factors, associated symptoms, and any neurologic deficits.
- Perform a direct ophthalmoscopy to check for optic disc edema.
- Refer to the emergency department (ED) immediately (or consult ophthalmology if already in the ED).
- Papilledema is an emergency: a delay in diagnosis and treatment could lead to permanent vision loss (or death, depending on the underlying cause).
What is the role of the ophthalmologist?
- Neuro-ophthalmologic imaging and evaluation to rule out other diagnoses
- Careful fundoscopic examination to categorize the severity of optic nerve swelling and track visual deficits over time
- Management and follow-up dictated by acuity
What is the treatment?
- Intracranial mass: resection, other appropriate measures
- Idiopathic: weight loss, acetazolamide, avoiding precipitating substances, managing other chronic conditions
- CSF shunting or optic nerve sheath fenestration if conservative measures unsuccessful
Learn more: Ophthalmology resources for medical students