Optic disc swelling from elevated intracranial pressure
Papilledema Evaluation and Treatment in Los Angeles
Papilledema — swelling of the optic disc due to elevated pressure around the brain — is a sign that something is increasing pressure inside your skull. It requires urgent evaluation to identify the cause, which can range from a brain tumor to a blood clot to IIH. Our Los Angeles neuro-ophthalmology practice provides expert, timely papilledema workups.
What is Papilledema?
Papilledema is swelling of the optic nerve head (optic disc) caused by elevated intracranial pressure (ICP). It is not a disease itself but a sign that something is raising the pressure inside the skull. Papilledema is typically bilateral (affecting both eyes) and can lead to permanent vision loss if the underlying cause is not identified and treated. It is distinct from other causes of optic disc swelling such as optic neuritis, NAION, or optic disc drusen. Accurate diagnosis requires a neuro-ophthalmologist who can distinguish these conditions and guide the appropriate workup.
Symptoms of Papilledema
- Headaches, often worse in the morning or when lying down
- Brief episodes of vision dimming or graying out (transient visual obscurations)
- Whooshing sound in the ears (pulsatile tinnitus)
- Double vision from sixth nerve palsy
- Blurred vision or enlargement of the blind spot
- Nausea and vomiting in severe cases
- May be asymptomatic — sometimes found incidentally on routine eye exam
Common Causes of Papilledema
- Brain tumors or other intracranial masses
- Idiopathic intracranial hypertension (IIH / pseudotumor cerebri)
- Cerebral venous sinus thrombosis (blood clot in brain veins)
- Meningitis or brain infections
- Hydrocephalus (obstruction of cerebrospinal fluid flow)
- Certain medications (tetracyclines, vitamin A, growth hormone)
- Intracranial hemorrhage
How We Evaluate Papilledema
Evaluation begins with a comprehensive dilated eye examination to confirm true papilledema and rule out mimics such as optic disc drusen or pseudopapilledema. Visual field testing and OCT document the degree of optic nerve involvement. Urgent brain MRI with MR venography is ordered to rule out a mass, hydrocephalus, or venous sinus thrombosis. If imaging is normal, a lumbar puncture measures the cerebrospinal fluid pressure and composition. This systematic approach ensures the underlying cause is identified safely and efficiently.
Treatment Options
Treatment is directed at the underlying cause of the elevated intracranial pressure. If a brain tumor is found, neurosurgical removal is typically indicated. For venous sinus thrombosis, anticoagulation is started. For IIH, weight loss and acetazolamide are first-line treatments. In all cases, the optic nerves must be closely monitored to prevent irreversible vision loss.
- Treatment of the underlying cause (tumor removal, anticoagulation for venous clot, etc.)
- Acetazolamide for IIH-related papilledema
- Weight loss program for IIH
- Optic nerve sheath fenestration for rapidly progressive vision loss
- CSF diversion surgery (shunt) for refractory cases
- Urgent neurosurgical referral when indicated
- Close visual field and OCT monitoring
Why Choose Dr. Ghiam for Papilledema
- Expert at distinguishing true papilledema from pseudopapilledema and other mimics
- Systematic, urgent workup to identify the underlying cause
- Close collaboration with neurosurgery, neurology, and neuroradiology
- Ongoing monitoring to prevent vision loss during treatment
- Fellowship-trained in the subspecialty most central to papilledema management
Papilledema sits squarely in the domain of neuro-ophthalmology. A neuro-ophthalmologist can confirm the diagnosis, distinguish it from mimics, guide the neuroimaging and lumbar puncture workup, monitor the optic nerves during treatment, and determine when surgical intervention is needed to protect vision.
Get Expert Help for Papilledema
If you or your doctor has identified swelling of the optic nerves, urgent evaluation by a neuro-ophthalmologist is essential. Contact our Encino office today for prompt evaluation.