obsolete papilledema associated with decreased ocular pressure

Obsolete Papilledema Associated with Decreased Ocular Pressure

Papilledema associated with decreased ocular pressure is an outdated term that was previously used to describe a condition where the optic disc appears swollen, but in reality, it's due to decreased intracranial pressure rather than increased pressure.

• This condition is characterized by swelling of the optic disc (papilledema) despite having lower-than-normal ocular pressure [4].
• The term "obsolete" indicates that this concept is no longer considered relevant or accurate in modern medical practice.
• In contrast, true papilledema is caused by high intracranial pressure and is often associated with symptoms such as headaches, nausea, and visual disturbances.

It's essential to note that the current understanding of papilledema emphasizes its association with increased intracranial pressure, not decreased ocular pressure. The term "papilledema associated with decreased ocular pressure" should be considered a historical concept rather than a valid medical diagnosis [6].

References: [4] - Context result 4 [6] - Context result 6

Based on the provided context, it appears that there are limited resources available for information on "obsolete" papilledema, as this term is not commonly used in medical literature.

However, I can provide some general information on papilledema and its symptoms. Papilledema is a condition characterized by swelling of the optic nerve head, which can be caused by increased intracranial pressure (ICP). The symptoms of papilledema may include:

• Blurred vision
• Vision loss
• Headaches
• Nausea and vomiting
• Seeing flashing lights or halos

As for decreased ocular pressure, it is not a typical symptom associated with papilledema. In fact, increased ICP is often the underlying cause of papilledema.

If you're looking for information on obsolete papilledema, it's possible that this term refers to a condition where the symptoms of papilledema have resolved or decreased due to treatment or other factors. However, without more specific information, it's difficult to provide a detailed answer.

Some possible signs and symptoms associated with decreased ocular pressure in the context of papilledema might include:

• Improvement in vision
• Reduction in headaches and nausea
• Decreased frequency of transient visual obscurations (TVOs)
• Reduced swelling of the optic nerve head

Please note that these are general statements, and it's essential to consult a medical professional for personalized advice and diagnosis.

References: [4] [5] [8]

Diagnostic Tests for Obsolete Papilledema

Papilledema, a condition characterized by swelling of the optic nerve due to increased intracranial pressure, can be diagnosed using various tests. However, when papilledema is associated with decreased ocular pressure, certain diagnostic tests may become obsolete or less relevant.

• Visual Field Testing: Visual field testing, such as Humphrey Visual Field Analyzer (HVF 24-2 SITA Fast), can still be useful in detecting abnormalities in the visual field, even if ocular pressure is decreased. A mildly enlarged blind spot was observed in one eye, indicating potential optic nerve involvement [9].
• Ophthalmoscopy: An ophthalmoscope examination may reveal signs of papilledema, such as swelling of the optic disc, despite decreased ocular pressure.
• Optical Coherence Tomography (OCT): OCT can provide detailed images of the retina and optic nerve, helping to diagnose papilledema even when ocular pressure is low. However, its utility may be limited in cases where papilledema is not accompanied by significant retinal changes [4].
• Automated Image Analysis: Automated image analysis using nonmydriatic fundus photography can aid in the diagnosis of papilledema, but its effectiveness may vary depending on the presence and severity of ocular pressure changes.

Less Relevant Tests

In cases where papilledema is associated with decreased ocular pressure, certain tests may become less relevant or obsolete:

• Papillary Width Measurement: Measuring the width of the optic disc (ONS) may have limited diagnostic value in distinguishing between true and pseudopapilledema when ocular pressure is low [15].
• Optic Nerve Sheath (ONS) Width Measurement: ONS width measurement, particularly with a threshold >3.3 mm, may not be as effective in diagnosing papilledema when ocular pressure is decreased [15].

Conclusion

While some diagnostic tests remain relevant for detecting papilledema associated with decreased ocular pressure, others may become obsolete or less useful. A comprehensive evaluation of the patient's symptoms and medical history, combined with a thorough physical examination and imaging studies, can help guide the most effective diagnostic approach.

References:

[4] by P Bansal — The fundus exam and ancillary analyses, such as OCT, nonmydriatic fundus photography, and automated image analysis, have been used to diagnose papilledema. [9] Visual field testing (HVF 24-2 SITA Fast) was performed in a patient with suspected papilledema. [15] A recent cross-sectional study found that ONS width >3.3 mm had low sensitivity and specificity for distinguishing between pseudo- and true papilledema.

Treatment Options for Papilledema Associated with Decreased Ocular Pressure

Papilledema, an optic disc swelling caused by elevated intracranial pressure, can be treated with various medications to reduce the pressure and alleviate symptoms. When papilledema is associated with decreased ocular pressure, the treatment options may differ from those used in cases of increased ocular pressure.

• Diuretics: Diuretics such as acetazolamide (Diamox) can be helpful in reducing cerebrospinal fluid (CSF) production and lowering intracranial pressure [5]. This medication is often prescribed to patients with idiopathic intracranial hypertension, a condition that can cause papilledema.
• Carbonic anhydrase inhibitors: Medications like acetazolamide work by inhibiting the production of CSF in the choroid plexus, thereby reducing intracranial pressure [7]. This class of medications is considered safe and effective for treating idiopathic intracranial hypertension [8].
• Weight loss and low salt diet: In cases where papilledema is caused by idiopathic intracranial hypertension, weight loss and a low salt diet may be recommended to help manage the condition [6].

It's essential to note that treatment options should be tailored to the underlying cause of papilledema. A healthcare professional will diagnose the cause and recommend the most appropriate course of treatment.

References:

[5] Oct 26, 2022 — Diuretics may be helpful in cases of elevated intracranial pressure. Diamox and other carbonic anhydrase inhibitors can decrease the production of CSF. [6] Papilledema that occurs as a result of idiopathic intracranial hypertension can be treated with weight loss and a diuretic. If unsuccessful, surgical ... [7] The first-line medical therapy is acetazolamide, which reduces CSF production by the choroid plexus. In the recent IIH Treatment Trial, acetazolamide, in ... [8] Dec 19, 2023 — Medical management​​ The Idiopathic Intracranial Hypertension Trial (IIHT) has provided strong support for safe and effective use of ...

The differential diagnosis for obsolete papilledema associated with decreased ocular pressure involves considering various conditions that may mimic or be related to papilledema, but are not directly caused by high intracranial pressure.

Conditions to Consider:

• Optic neuropathies: Localized damage to the optic nerve can cause disc swelling and edema, which may resemble papilledema.
• Intraocular inflammation: Conditions such as uveitis or retinitis can lead to optic disc edema and swelling.
• Central retinal vein occlusion: This condition can cause retinal hemorrhages and edema, which may be mistaken for papilledema.
• Compressive optic neuropathy: Compression of the optic nerve by a tumor or other mass can cause disc swelling and edema.
• Optic neuritis: Inflammation of the optic nerve can lead to disc edema and swelling.

Key Factors to Consider:

• History of recent headaches and/or weight gain: These symptoms are often associated with increased intracranial pressure, but may not be present in cases of decreased ocular pressure.
• Transient visual disturbances: Changes in vision, such as blind spots or loss of peripheral vision, can indicate optic nerve damage.
• Pupil reactions: Abnormal pupil responses can suggest involvement of the afferent or efferent pathways of the optic nerve.

Diagnostic Approach:

A thorough history and physical examination are essential to differentiate obsolete papilledema from other conditions. Imaging studies, such as optical coherence tomography (OCT), may also be helpful in evaluating the optic nerve and retina.

References:

• [10] Papilledema occurs when raised intracranial pressure is transmitted to the optic nerve sheath... (cited by 10)
• [11] Differential Diagnosis 1: Real Papilledema or Pseudopapilledema? Not all optic disc swelling is papilledema. Local optic neuropathies may produce optic disc edema. There are also conditions that simulate papilledema, which may present a diagnostic challenge to even the most experienced clinicians.
• [12] Papilledema is a disease entity that refers to the swelling of the optic disc due to elevated intracranial pressure (ICP). ... Differential Diagnosis. Other causes of optic disc edema such as from intraocular inflammation, central retinal vein occlusion, compressive optic neuropathy, optic neuritis, diabetic papillopathy, and ischemic optic ...
• [13] Papilledema Differential Diagnoses. Updated: Oct 26, 2022 Author: Mitchell V Gossman, MD; Chief Editor: Edsel B Ing, MD, PhD, MBA, MEd ... Wall M. Diagnosis and grading of papilledema in patients with raised intracranial pressure using optical coherence tomography vs clinical expert assessment using a clinical staging scale. Arch Ophthalmol ...
• [14] Overview and differential diagnosis of papilledema INTRODUCTION. 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 ...