C i.e. Sudden painless loss of vision In papilloedema there is painless gradually progressive loss of vision which is usually bilateralQ which occurs after a long time only when optic atrophy sets in. "Visual acuity is not affected by Papilloedema unless it is severe, long standing, or accompanied by macular edema & haemorrhage"-Harrison's P 169 In contrast, in papillitis there is U/L sudden & marked painful loss of vision with ocular tenderness at inseion of MR & SRQ (medial & superior rectus), which is accompanied by pain on ocular movements, pulfrich phenomenon & RAPD Q. Papilloedema It is hydrostatic noninflammatory oedema of optic disc or nerve head d/t raised intracranial pressure. Aetiology Pathogenesis Clinical Features * Raised ICT, which may be due * Old concept? * General features of raised ICT ? to compression of central headache, nausea, projectile 1. Congenital condition - retinal veinQ as it vomiting, diplopia & focal aqueductal stenosis, crosses the subdural & neurological deficit craniosynostosis subarachnoid spaces, * Ocular features 2. Intracranial Space Occupying while thicker wall Lit Painless progressive loss of lesions (ICSOLS) - eg brain aery continue to visionQ with the following tumor, gumma, hematoma, transmit blood sequence of symptoms: aneurysm, infection * New Hayreh's theory - Ther are no visual symptoms & - Papilloedema is most frequent - Papilloedema develops acuity is normal in Early with tumors arising in posterior as a result of stasis of papilloedema fossa (cerebellum, mid brain, axoplasm in - Reccurent attacks of transient parieto occipital region)Q which prelaminar regioinQ of black out of vision (amaurosis obstruct aqueduct of sylvius and optic disc due to an fugax)Q precipitated by change in least with pituitary tumors alteration in the posture - Papilloedema due to tumors of pressure gradient - Enlargement of blind spot & anterior fossa is relatively rare and across lamina cribrosa progressive contraction of visual occurs late in the course of - Raised ICT & orbital fieldQ disease lesion produce - Relative scotoma first to green & - ICSOLS in any position (even disturbance in red spinal cord) excepting medulla pressure gradient by - Visual acuity & pupillary oblongataQ may induce increasing tissue reaction remain normal until papilloedema pressure with in the optic atrophy sets inQ which may 3. Intracranial infections retrolaminar region lead to severe lossof central (meningitis, encephaliltis), while ocular hypotony vision intracranial haemorrhages, alters it by lowering - As optic atrophy sets in complete obstruction of CSF absorption the tissue pressure blindness ensues & pupils arachnoid villi with in prelaminar become large & immobile. 4. Systemic conditions eg. malignant hyper tensionQ, toxaemia of pregnancyQ, area Mnemonic- "Blurring Has Reduced * Fundoscopic features Physiological Pulse So 26 Elevated cardiopulmonary insufficiency, blood dyscarasis & nephritis Fans Must Flame the Cotton" 5. Pseudotumor cerebriQ usually due to drugs like Tetracycline, Blurring Blurring of margins of optic discQ vitamin A, Nalidixic acid, Has Hyperaemia of disc Contraceptive (oral) & Reduced - Reduced Physiological cupQ CoicoSteroid Physiological - Pulsation (venous) may be absent() (Memonic - " TANCS") Pulse So Striated appearance d/t prominent small aerioles * Ocular hypotony & 2-6 - 2-6 DQ difference for focusing vessels on disc on Foster Kennedy SyndromeQ retina d/t elevation of disc F.K. Syndrome is associated Elevated Elevated discQ (mushroom or dome shaped)Q with olfactory or sphenoidal Fans Must Macular FanQ - an incomplete star with temporal meningiomata & frontal lobe pa missing tumor. These compress optic Flame - Flame shaped & Punctate haemorrhage() nerve on same side 1/t The pressure optic atrophy C/L papilloedemaQ (d/t raised ICT) Cotton - Cotton wool spotsQ