papilledema papilledema papilledema or papilloedema is optic disc swelling that is caused by increased intracranial pressure due to any cause. the swelling is usually bilateral and can occur over a period of hours to weeks. unilateral presentation is extremely rare. papilledemafundal photograph showing severe papilledema in the left eyespecialtyophthalmology, optometry, neuro-ophthalmology, neurology, neurosurgery in intracranial hypertension, the optic disc swelling most commonly occurs bilaterally. when papilledema is found on fundoscopy, further evaluation is warranted because vision loss can result if the underlying condition is not treated. further evaluation with a ct or mri of the brain and/or spine is usually performed. recent research has shown that point-of-care ultrasound can be used to measure optic nerve sheath diameter for detection of increased intracranial pressure and shows good diagnostic test accuracy compared to ct. thus, if there is a question of papilledema on fundoscopic examination or if the optic disc cannot be adequately visualized, ultrasound can be used to rapidly assess for increased intracranial pressure and help direct further evaluation and intervention. unilateral papilledema can suggest a disease in the eye itself, such as an optic nerve glioma. signs and symptoms fundal photograph showing severe papilloedema in the right eye. in the early stages, papilledema may be asymptomatic or present with a headache. it can progress to enlargement of the blind spot, blurring of vision, visual obscurations (inability to see in a particular part of the visual field for a period of time). ultimately, total loss of vision can occur. papilledema (right) revealed by scanning laser ophthalmoscopy (top) and laser doppler imaging (bottom). healthy contralateral eye (left). the signs of papilledema that are seen using an ophthalmoscope include: venous engorgement (usually the first signs) loss of venous pulsation hemorrhages over and/or adjacent to the optic disc blurring of optic margins elevation of the optic disc paton's lines (radial retinal lines cascading from the optic disc) on visual field examination, the physician may elicit an enlarged blind spot; the visual acuity may remain relatively intact until papilledema is severe or prolonged. causes raised intracranial pressure as a result of one or more of the following: smoking brain tumor, idiopathic intracranial hypertension (also known as pseudotumor cerebri), cerebral venous sinus thrombosis or intracerebral hemorrhage respiratory failure hypotonia isotretinoin, which is a powerful derivative of vitamin a, rarely causes papilledema. medications like tetracycline hypervitaminosis a, in some people who take megadoses of nutritional supplements and vitamins. hyperammonemia, elevated level of ammonia in blood (including cerebral edema/intracranial pressure) guillain–barré syndrome, due to elevated protein levels poems syndrome, a paraneoplastic syndrome that can cause increased intracranial pressure. foster kennedy syndrome (fks) chiari malformation tumors of the frontal lobe acute mountain sickness and high-altitude cerebral edema lyme disease (lyme meningitis specifically, when the bacterial infection is in the central nervous system, causing increased intracranial pressure). malignant hypertension medulloblastoma obesity orbital glaucoma: central retinal vein occlusion, cavernous sinus thrombosis local lesion: optic neuritis, ischemic optic neuropathy, methanol poisoning, infiltration of the disc by glioma, sarcoidosis and lymphoma acute lymphocytic leukemia (caused by infiltration of the retinal vessels by immature leukocytes) long periods of weightlessness (microgravity) for males (