Papilledema, Vision Loss, and Hydrocephalus

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What is Papilledema?

Papilledema is an optic disc swelling that is secondary to elevated intracranial pressure around the brain.(1)

Papilledema can be very dangerous and can cause blindness. Patients should be periodically examined for papilledema so that timely ICP-lowering measures can be instituted to preserve vision.(2) It is critical that the patients consult with an ophthalmologist or a neuro-ophthalmologist (they may need to get a referral from their neurosurgeon). These specialists are not always easy to find, however, you may use American Academy of Ophthalmology’s website to locate one in your area. A thorough shunt check may be needed. They may need to undergo a spinal tap or ICP monitoring to determine the level of ICP. The biggest concern with increased intracranial pressure is there is always the potential for visual loss secondary to the papilledema. If the shunt is not working and the ventricles are non-responsive then there is a very serious concern that if the shunt is not fixed the patient is at risk for going blind.

Most symptoms in a patient with papilledema are secondary to the underlying elevation in intracranial pressure.(3)

  • Headache: Increased intracranial pressure headaches are characteristically worse on awakening, and they are exacerbated by coughing or other type of Valsalva maneuver.
  • Nausea and vomiting: If the rise in intracranial pressure is severe, nausea and vomiting may occur.
  • Pulsatile tinnitus
  • Some of these visual symptoms can occur:
    • Some patients experience transient visual obscurations (graying-out of their vision, usually both eyes, especially when rising from a lying or sitting position, or transient flickering as if rapidly toggling a light switch).
    • Blurring of vision, constriction of the visual field, and decreased color perception may occur.

How Does Hydrocephalus Injure the Eye?

Visual information is transmitted to the brain by the optic nerve, a cord that runs from the eye to the brain. The meninges that surround the brain and spinal cord also surround the optic nerve. Thus, increases in CSF pressure around the brain can also produce pressure on the optic nerve.

This pressure chokes off the supply of food and oxygen to the optic nerve, causing it to swell. The nerve can be damaged through high CSF pressure or because of lower pressure elevation that lasts for a prolonged time period. Damage to the optic nerve from papilledema can result in reduced vision, reduced color vision, and visual field loss.(4)

Since some children and adults with hydrocephalus can develop different eye problems and high cerebrospinal fluid (CSF) pressure can damage vision, it is important for patients to have periodic checkups for any vision issues.

To learn more about papilledema and other eye problems and hydrocephalus please use the following resources:

  • Download and read our information sheets:

Eye problems Associated with Hydrocephalus

Life-Threatening Complications of Hydrocephalus

Blog written by Karima Roumila, Director of Support and Education

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(1) Whiting AS, Johnson LN: Papilledema: clinical clues and differential diagnosis. Am Fam Physician. 1992 Mar;45(3):1125-34.

(2) Trobe JD. Papilledema: the vexing issues., J Neuroophthalmol. 2011 Jun; 31(2):175-86.

(3) http://emedicine.medscape.com

(4) Fact Sheet: Eye problems Associated with Hydrocephalus

(5) Hydrocephalus Resource Library

 

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