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Papilloedema - Draft

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Overview

Patients with suspected optic disc swelling or more specifically papilloedema should be considered to have an intracranial mass until proved otherwise. (1)

(1) Optic Disc Swelling (including Papilloedema) | Patient

Pseudopapilloedema is apparent optic disc swelling due to an underlying benign process.

Patients are usually asymptomatic with the finding incidental.

The condition should be managed as true optic disc swelling until proven otherwise. 

Who to Refer

All patients with papilloedema will need to be referred for imaging or further specialist investigation with urgency depending on the suspected underlying cause.

For a list of possible causes of Papilloedema see Optic Disc Swelling (including Papilloedema) | Patient

Red Flags

Patients with Papilloedema and symptoms and/or signs of raised intracranial pressure should be admitted to hospital (999) for emergency investigation.

The combination of headache, papilloedema  and vomiting is generally considered indicative of raised intracranial pressure. However, raised ICP may also present with other symptoms (2).

(2) Raised Intracranial Pressure (Causes, Symptoms, and Treatment) | Patient

Symptoms and signs of raised ICP

Headache - more worrying when nocturnal, starting when waking, worse on coughing or moving head and associated with altered mental state

Mental State - Early changes in mental state include lethargy, irritability, slow decision making and abnormal social behaviour. 

Vomiting (in early stages without nausea) -  can progress to projectile with rising intracranial pressure.

Pupillary changes - including irregularity or dilatation in one eye.

Optic disc swelling - fundoscopy shows blurring of the disc margins, loss of venous pulsations, disc hyperaemia and flame-shaped haemorrhages. In later stages, obscured disc margins and retinal haemorrhages may be seen.

Cranial nerve palsies - Unilateral ptosis or third and sixth nerve palsies. In later stages, ophthalmoplegia and loss of vestibulo-ocular reflexes.

Late signs - include motor changes (hemiparesis), raised blood pressure, widened pulse pressure and slow irregular pulse.

Referral

Refer to your local ED (999) immediately if patient has symptoms and signs of raised ICP.

If patient is asymptomatic, then less urgent investigation may be considered

?Refer for MRI

? Refer to ophthalmology

? Refer to neurology



Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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