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Overview and differential diagnosis of papilledema

Don C Bienfang, MD
Section Editor
Paul W Brazis, MD
Deputy Editor
Janet L Wilterdink, MD


While the term papilledema is often used broadly to denote a swollen optic nerve head, the term papilledema should be reserved for optic disc swelling that is due to raised intracranial pressure.

This topic will provide an overview and differential diagnosis of papilledema. The entity of increased intracranial pressure and specific causes of papilledema are discussed elsewhere. (See "Evaluation and management of elevated intracranial pressure in adults".)


Papilledema occurs when raised intracranial pressure is transmitted to the optic nerve sheath. The raised pressure mechanically disrupts axoplasmic flow within the nerve. Obstipation of intra-axonal fluid results in swelling of the axons and leakage of water, protein, and other cellular contents into the extracellular space of the optic disc giving rise to optic disc edema [1,2]. Venous obstruction and dilation, nerve fiber ischemia, and vascular telangiectasias are secondary phenomena.

Any entity that increases intracranial pressure may lead to papilledema. These include:

Intracranial mass lesions (eg, tumor, hematoma)


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Literature review current through: Sep 2016. | This topic last updated: Jun 26, 2016.
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