Edema and inflammation of the optic nerve at its point of entrance into the eyeball, also known as choked disk.

Papilledema may be caused by increased intracranial pressure often due to a tumor or abscess of the brain (see Diagnostic Code: 8020 Brain, abscess of) pressing on the optic nerve. It may also be due to trauma, encephalitis (see diagnostic code: 8000 encephalitis, epidemic, chronic), malignant hypertension, obstruction to the venous drainage of the eye, optic neuritis (see diagnostic code: 6026 optic neuropathy), papillitis, ischemic optic neuropathy, Pseudo tumor cerebri, juvenile diabetic papillopathy or thrombosis of the central retinal vein.

Vision loss, varying from a small central or paracentral scotoma to complete blindness and frequently maximal within 1-2 days, is the major symptom. Edema of the optic nerve is characterized by a swollen optic disk, which displays blurred or absent disk margins and dilated vessels. Frequently, hemorrhages, exudates, and cotton-wool spots are seen. Folds of the choroid and retina may surround the optic nerve.

Tests that may be used to diagnose the condition include: ophthalmoscopy; visual field, using confrontation; and Snellen test. In addition, x-ray; computed tomography (CT) scan; or magnetic resonance imaging (MRI) may be performed to evaluate for the presence of a tumor or abscess.

Treatment for papilledema will vary depending on the cause of the condition. It may include antibiotics; control of blood pressure; measures to decrease intracranial pressure; treatment to remove or decrease the size of a tumor including surgical removal; radiation therapy; chemotherapy; repeated lumbar punctures; diuretics and corticosteroids. Surgical perforation or creation of a new opening in the optic nerve sheath or a lumboperitoneal shunt may halt the progression of visual loss.

As papilledema progresses, swelling of the disk enlarges the normal blind spot, and atrophic changes of the optic nerve occur, leading to a loss of visual acuity. Blindness may result very rapidly unless papilledema is relieved. Once vision loss occurs, it may be permanent regardless of treatment.

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