Papilledema is swelling of the optic nerve head (optic disc) that happens because pressure inside the skull is abnormally high. It matters because papilledema isn’t a standalone eye disease—it’s a visible warning sign that something is raising intracranial pressure, and prolonged swelling can lead to permanent optic nerve damage and vision loss.
What is Papilledema?
Papilledema (sometimes called “choked disc”) is optic disc swelling specifically caused by elevated intracranial pressure (ICP)—not just any swollen optic nerve. It usually affects both eyes, although it can be uneven between eyes and is only rarely truly one-sided.
Papilledema vs. other “swollen disc” findings
Not every elevated-looking optic disc is papilledema, and this distinction is important because the urgency and workup can differ. For example, “pseudopapilledema” means the disc looks elevated but not due to true swelling from high ICP.
Causes and Risk Factors
Papilledema happens when elevated intracranial pressure is transmitted along the fluid space around the optic nerve, disrupting normal flow within nerve fibers and leading to swelling at the optic disc. In practice, the key question becomes: what is raising the pressure inside the skull?
Common causes clinicians consider include:
- Idiopathic intracranial hypertension (IIH), meaning raised ICP without a mass or other clear structural cause; it’s described as a common cause of papilledema, especially in people under 50.
- Space-occupying lesions (such as tumors) or hemorrhage that increase intracranial volume.
- Cerebrospinal fluid (CSF) flow obstruction and hydrocephalus (too much CSF accumulating).
- Infections or inflammation affecting the brain or its coverings (for example, meningitis/encephalitis).
- Cerebral venous sinus thrombosis (a clot in veins that drain the brain), which can raise pressure by impairing venous outflow.
Risk factors depend on the cause, but IIH is strongly associated with obesity and is most prevalent in women of childbearing age with obesity. Cleveland Clinic similarly notes papilledema is more common in women aged 20–44 with overweight/obesity and provides incidence estimates for that group (13 per 100,000) and for the overall U.S. population (0.9 per 100,000).
Common Signs and Symptoms
Papilledema itself is a finding an eye clinician sees on examination, but people often feel symptoms from the elevated intracranial pressure driving it. Common symptom patterns include:
- Headache, which can worsen with positions or situations that increase intracranial pressure.
- Brief episodes of dimming or “graying out” of vision (transient visual obscurations/dim-outs).
- Blurry vision and visual field changes (often affecting side vision).
- Nausea and vomiting with acute rises in intracranial pressure.
- Pulsatile tinnitus (a rhythmic “whooshing” in the ear in time with the heartbeat), which can be associated with raised ICP.
A tricky point: some people have minimal symptoms early on, even when papilledema is present, which is one reason clinicians take it seriously and prioritize timely evaluation.
How the Condition is Diagnosed
Diagnosis has two goals: (1) confirm the optic disc appearance truly represents papilledema (not a mimic), and (2) identify the cause of the raised intracranial pressure. Because papilledema can signal potentially dangerous conditions, it’s often treated as an urgent diagnostic problem.
Typical components of a workup may include:
- Dilated eye exam/fundus evaluation to assess the optic disc and look for signs consistent with papilledema (blurred disc margins, vascular changes, hemorrhages, etc.).
- Visual field testing (formal perimetry) to document and monitor side-vision loss, which can occur with papilledema.
- Optical coherence tomography (OCT) to measure and track optic nerve head/nerve fiber layer changes over time (used as part of evaluation and monitoring).
- Neuroimaging—often contrast-enhanced MRI of the brain (and sometimes orbits) and MR venography (MRV)—to look for masses and venous sinus thrombosis and to support evaluation for IIH.
- Lumbar puncture (spinal tap) to measure opening pressure and analyze CSF, typically after imaging confirms it’s safe to proceed.
Clinicians may also grade papilledema severity using the Frisén scale (a standardized staging system).
Treatment Options Explained (non-prescriptive, informational)
Papilledema treatment focuses on addressing the underlying cause of raised intracranial pressure, because papilledema is a sign rather than a root diagnosis. The exact plan is individualized and usually involves coordination between ophthalmology/neuro-ophthalmology, neurology, and sometimes neurosurgery.
Depending on the cause, treatment may involve:
- Treating a mass lesion or hemorrhage with appropriate specialist care, including possible surgery.
- Treating infections/inflammatory causes with urgent targeted management directed by the underlying diagnosis.
- Managing cerebral venous sinus thrombosis, including evaluation for triggers and specialist-directed treatment (often involving anticoagulation).
- For idiopathic intracranial hypertension (IIH): strategies aimed at lowering intracranial pressure and protecting vision, commonly including weight loss and medications such as acetazolamide.
Evidence supports the role of weight management in IIH and shows that, in a randomized clinical trial setting, acetazolamide combined with a weight reduction program improved visual outcomes and reduced papilledema in participants with mild visual loss. If vision is severely threatened or not improving, some patients require procedures to lower pressure more directly (for example, optic nerve sheath fenestration or CSF shunting), and selected patients may be considered for venous sinus stenting when appropriate.
Possible Complications if Left Untreated
Persistently elevated intracranial pressure can cause progressive optic nerve fiber damage, leading to worsening visual field loss and eventually reduced central vision. Cleveland Clinic notes that untreated papilledema can lead to partial or complete blindness in one or both eyes.
Complications can also relate to interventions when they’re needed—for instance, shunts can malfunction or obstruct, and any procedure involving access to CSF spaces carries infection risk. That’s why follow-up and monitoring of both vision function (like visual fields) and optic nerve appearance are central to care.
Prevention and Risk Reduction (if applicable)
Not all causes of papilledema are preventable, because some are unpredictable (such as certain masses, hemorrhages, or infections). Still, risk reduction may be possible in specific contexts—most notably IIH, where weight loss is commonly associated with improvement and is often part of management strategies.
Regular eye exams can help detect optic disc swelling earlier, including in people who don’t yet notice clear symptoms. Seeking care promptly for new or worsening headaches plus visual changes (or nausea/vomiting) may also reduce the chance of delayed diagnosis.
When to See an Eye Doctor
Papilledema is widely treated as urgent because intracranial hypertension can be serious and potentially life-threatening. Seek prompt medical evaluation (often the same day or emergency care, depending on severity) if you have concerning combinations such as new/worsening headache with visual changes, repeated brief vision dimming episodes, or vision changes with nausea/vomiting.
If an eye care professional tells you your optic disc looks swollen—or mentions papilledema or “possible papilledema”—ask what the recommended timing is for neuroimaging and further evaluation.
Frequently Asked Questions (FAQ)
No—papilledema is optic disc swelling caused by raised intracranial pressure, while optic neuritis is inflammation of the optic nerve and is part of a different differential diagnosis clinicians consider when evaluating optic disc edema.
Yes, some people can be asymptomatic or have subtle symptoms, and papilledema may be discovered during an eye exam done for another reason.
People may notice brief “dim-outs” (transient visual obscurations), blurred vision, or side-vision (visual field) changes, which is why visual field testing is commonly used for monitoring.
MRI helps evaluate for causes like masses, and MRV is used to assess for venous sinus thrombosis; both are part of recommended evaluation to identify the underlying cause of raised intracranial pressure.
Not always, but it may be used to measure opening pressure and analyze CSF when imaging indicates it’s safe and clinicians need more information about intracranial pressure and possible causes.
IIH is elevated CSF pressure without a mass lesion and is described as a common cause of papilledema (including as the most common cause in some references).
It can if high intracranial pressure persists long enough to damage optic nerve fibers, and reputable patient resources warn that untreated papilledema can cause partial or complete blindness.
Key Takeaways
- Papilledema is optic disc swelling caused by elevated intracranial pressure, usually in both eyes.
- The priority is identifying why intracranial pressure is high (for example IIH, mass lesions, CSF flow problems, infection/inflammation, or venous sinus thrombosis).
- Diagnosis commonly includes a dilated eye exam, visual field testing, OCT, neuroimaging (MRI ± MRV), and sometimes lumbar puncture when safe.
- Treatment targets the underlying cause and may include weight management and acetazolamide in IIH, with procedures considered when vision is threatened or response is inadequate.
Medically reviewed / Educational disclaimer
This article is for education and does not diagnose conditions or replace care from an eye doctor, neurologist, or emergency clinician. It summarizes established medical concepts from reputable references including StatPearls/NCBI Bookshelf, Cleveland Clinic, and MSD Manuals (Merck Manual), which you can read here: StatPearls—Papilledema (NCBI Bookshelf), Cleveland Clinic—Papilledema, and MSD Manual Consumer—Papilledema.
