Optic nerve conditionsPapilledema

● It refers to bilateral swelling of the optic disc from increased intracranial pressure

● It must be distinguished from optic disc swelling from other causes, which is simply termed "optic disc edema". Papilledema must also be distinguished from pseudo papilledema such as optic disc drusen.

● The root cause of papilledema is increased intracranial pressure (ICP), which is an alarming sign, and which may presage such entities as brain tumor, central nervous system inflammation or idiopathic intracranial hypertension

● Papilledema results from orthograde axoplasmic flow stasis at the optic nerve head leading to edema of the nerve from the increased intracranial pressure pressing on the nerve behind the eye

● Continued pressure can result in loss of axons and eventual optic atrophy● With optic atrophy there is little or no edema seen even with continuing

increased intracranial pressure, since there are no fibers left to swell

Papilledema Grading System (Frisen Scale):● Stage 1 - Very Early Papilledema: obscuration of the nasal border of the

disc. No elevation of the disc borders. Normal temporal disc margin.● Stage 2 - Early Papilledema: obscuration of all borders. Elevation of the

nasal border. Complete peripapillary halo.● Stage 3 - Moderate Papilledema: obscurations of all borders. Increased

diameter of optic nerve head. Obscuration of one or more segments of major blood vessels. Peripapillary halo - irregular outer fringe with finger-like extensions.

● Stage 4 - Marked Papilledema: elevation of the entire nerve head. Obscuration of all borders. Peripapillary halo. Total obscuration on the disc of a segment of a major blood vessel.

● Stage 5 - Severe Papilledema: dome-shaped protrusions representing anterior expansion of the optic nerve head. Peripapillary halo is narrow and smoothly demarcated.

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Early papilledema

Moderate papilledema

Severe papilledema

Resolved papilledema