Detection of Papilloedema

Key points
Key examination signs

Papilloedema is swelling of the optic nerve head (optic disc) due to raised intracranial pressure. See Figure below.

Key points

• It may take several hours to develop after a sudden elevation of the intracranial pressure and longer with a gradual elevation.
• It is usually bilateral (but can be unilateral)
• Ophthalmoscopic detection is difficult and it is recommended that it is only excluded after a confident examination with a dilated pupil.
• Visual loss is rare and if present usually limited to brief loss of vision lasting a few seconds (visual obscurations).
• The presence of venous pulsations on the discs suggest there is not raised intracranial pressure but this is a difficult sign to see and they are absent in about 10% of the normal population.

Key examination signs

5 mechanical and 5 vascular signs

Mechanical:

• Elevation of the nerve (can look like a champagne cork pushing into the eye)
• Loss of the cup
• The margin of the disc becomes obscured
• Retinal folds
• Hard exudates

Vascular:

• Hyperaemia of the disc
• Engorgement and tortuosity of the veins
• Cotton wool spots
• Haemorrhages around the disc
• Loss of vessels as they cross the margin of the disc