What is Optic Disc Swelling?
Optic disc swelling (ODS) or papilledema is a condition where the optic nerves are affected. It is a common problem that affects children and adults. ODS is caused by trauma such as falls, car accidents, sports injuries, burns etc.
The optic nerves supply the eye with light. When they become damaged, it causes blindness. There are two types of optic nerve damage:
Blindness – the part of the optic nerve that supplies light is destroyed completely. In this case, blindness occurs.
Vision loss – the part of the optic nerve that supplies light becomes damaged severely. In this case, a decrease in vision occurs.
What are the different types of papilledema?
Papilledema has two types based on its causes:
1. Ischemic papilledema
Ischemic papilledema is caused by low blood flow to the optic nerve. It is the most common type of ODS and about 90% of all cases are this type.
2. Inflammatory papilledema
Inflammatory papilledema is caused by the inflammatory process of the nerve.
What are the symptoms of papilledema?
1. Blurry or cloudy vision
2. Swelling of the optic disk
3. Colored halos around lights or a halo that surrounds everything you see
4. Floaters or flashing lights
5. Loss of side vision
6. Pain behind the eye or in the forehead
7. Difficulty seeing at night
8. Double vision
9. Sensitivity to light
10. Changes in color perception
How is papilledema diagnosed?
1. Visual Field test – In this test, you will be asked to identify symbols on a screen.
This is done to check your field of vision.
2. Eye examination – The doctor will look for swelling, abnormal growths, or anything else that appears to be wrong.
3. Eye pressure test – This test is used to see if there is increased pressure in the eye.
4. Tonometry – The focus here is to measure the pressure inside your eye.
This can be done with a finger attached to a special instrument or with an instrument that uses light to measure.
5. Optical coherence tomography (OCT) – This test uses light to create a cross-sectional image of your eye.
6. X-ray – This test is used to see if there is a structural problem in your eye.
How is papilledema treated?
The treatment for papilledema depends on the cause.
1. Antibiotics – These are used to treat infections caused by bacteria.
2. Corticosteroids – These are used to reduce inflammation caused by conditions such as iritis and cyclitis.
3. Surgery – This is used to drain the fluid from the eye and the brain.
4. Medication – This is used to lower pressure in the eye.
5. Laser surgery – This is used to destroy abnormal blood vessels in the eye.
Optic nerve swelling home treatment
1. Try over the counter or prescription meds to reduce pressure.
2. Stay away from known trigger.
3. Wear sunglasses to protect your eyes.
4. Give your eyes a rest by closing them for 15-20 minutes every 2-3 hours.
5. See a doctor immediately for more serious cases.
Papilledema treatment options
Antiglaucoma eye drops can be used to reduce the pressure in the eye and prevent further damage to the optic nerve.
A steroid such as prednisolone can be used to reduce the swelling.
2. Eye surgery
An operation can be used to drain the fluid from around the optic nerve. A laser can also be used to destroy abnormal blood vessels in the eye.
3. Stem cell treatment
Stem cell therapy uses cells to treat conditions such as vision loss or spinal cord injury. The damaged area of the body is re-grown with new cells.
The stem cells are taken from amniotic fluid, bone marrow or fat. They are then grown and turned into the required type of cell. These cells are then injected into the body.
4. Radiation therapy
With the help of a machine that delivers radiation to the optic nerve, the swelling can be reduced. However, this procedure is not commonly used.
5. Vision rehabilitation
A low vision specialist can help you learn to adapt to the loss of vision. You can work on making your home safer and learn new ways to do daily tasks.
You can use computer software to change how the information on a computer screen is displayed. This can make it easier to see. Work with an occupational therapist to find the right software for you.
Surgery can be used to repair the blood vessels in your eye. The ophthalmologist can also replace your lens to cure your cataracts.
The final step in treating papilledema is to lower the pressure inside the eye. This is known as optic nerve decompression. This will take several months to work. It may be necessary to have surgery to drain excess fluid from the eye.
Optic nerve decompression
1. The ophthalmologist makes a small cut in the belly of your eye to drain the fluid.
2. A small cut is made on the back of your eye and a shunt is placed.
3. This shunt will drain fluid from your eye.
The success rate of this procedure is high, but some people do lose all vision after the surgery.
If the papilledema is caused by multiple sclerosis, no treatment can prevent future vision loss.
Papilledema treatment timeline
1. The swelling disappears in one to two weeks
2. The color of your vision returns in three to four weeks
3. It may take up to six months for the nerve damage to heal
4. If you still have symptoms by three months, you should have an optic nerve evaluation
5. If you still have vision loss after six months, you should have an MRI to check for new damage
6. If you still have vision loss after a year, it is permanent.
Papilledema long term effects
If left untreated or if the condition is particularly severe, there are a number of different long-term complications that can develop. These can include:
Retinal artery occlusion – where the arteries feeding blood to the retina are blocked. This is a medical emergency and can lead to sudden and permanent loss of vision in that eye.
Retinal detachment – where the retina becomes separated from the layer of cells underneath it. This is also a medical emergency and can lead to sudden and permanent loss of vision in that eye.
Optic Nerve Damage – the swelling of the optic nerve may cause it to stop working properly or even become damaged. This can cause a reduction in vision or even complete vision loss.
How should I prepare for treatment?
Make sure you have made an appointment with a qualified ophthalmologist. Tell your doctor about any medications, supplements or other drugs you are taking. You may be asked to stop taking some medications up to a week before the procedure.
How it feels
You will lie on an examining table while the doctor examines your eyes.
There are few risks to this procedure. Some people experience mild discomfort or blurred vision that lasts for a few days after the test.
You should be able to return to your normal day-to-day activities immediately after the test. Check with your doctor about when you can return to work and any changes to your normal activities.
Learn more about Glaucoma Symptoms, Causes and Treatment.
Sources & references used in this article:
- Automated quantification of volumetric optic disc swelling in papilledema using spectral-domain optical coherence tomography (JK Wang, RH Kardon, MJ Kupersmith… – … & visual science, 2012 – tvst.arvojournals.org)
- Automated 3D region-based volumetric estimation of optic disc swelling in papilledema using spectral-domain optical coherence tomography (JK Wang, MS Miri, RH Kardon… – Medical Imaging 2013 …, 2013 – spiedigitallibrary.org)
- Optic disc edema (GP Van Stavern – Seminars in neurology, 2007 – thieme-connect.com)
- Optical coherence tomography angiography in optic disc swelling (MA Fard, J Jalili, A Sahraiyan, H Khojasteh… – American journal of …, 2018 – Elsevier)
- Papilledema: clinical clues and differential diagnosis. (AS Whiting, LN Johnson – American family physician, 1992 – ncbi.nlm.nih.gov)
- Optic disc edema in raised intracranial pressure: IV. Axoplasmic transport in experimental papilledema (JJ Jung, SH Baek, US Kim – Korean Journal of Ophthalmology, 2011)