eye disorders
Papilledema
Symptoms and Signs of Papilledema
In patients with papilledema, vision is usually not affected initially, but seconds-long graying out of vision, flickering, or blurred or double vision may occur. Patients may have symptoms of increased intracranial pressure, such as headache or nausea and vomiting. Pain is absent. Ophthalmoscopic examination reveals engorged and tortuous retinal veins, a hyperemic and swollen optic disk (optic nerve head), and retinal hemorrhages around the disk but not into the retinal periphery. Isolated disk edema (eg, caused by optic neuritis or ischemic optic neuropathy) without the retinal findings indicative of elevated cerebrospinal fluid pressure is not considered papilledema (unless the intracranial pressure is elevated on concurrent lumbar puncture). In the early stages of papilledema, visual acuity and pupillary response to light are usually normal and become abnormal only after the condition is well advanced. Visual field testing may detect an enlarged blind spot. Later, visual field testing may show peripheral vision loss with arcuate defects that follow the nerve fiber bundle defects. 