PAPILLEDEMA

Normally the optic nerve disc is flush with the retina. In papilledema, intracranial pressure (pressure in the brain cavity) is so high that the optic nerve protrudes into the eye.

Increased intracranial pressure can occur if there are space-occupying lesions in the brain, such as tumors. There is a condition called pseudotumor cerebri where the intracranial pressure is high but there is no space-occupying lesion. The patient often suffers from headaches and ringing in the ears. It often occurs in young, overweight females. This was a patient I saw this week who came in for a routine eye examination.

A space-occupying brain lesion needs to be ruled out with imaging and often a lumbar puncture is performed to confirm the increased intracranial pressure and rule out other possible problems.

FAMILIAL DOMINANT DRUSEN

These photos show the retina of a patient with familial dominant drusen. Normally the retina has a very smooth, unblemished look. In this case, the little white dots are called drusen. Drusen are deposits of lipid between the retina and the laster beneath it. Normally drusen are associated with macular degeneration. But macular degeneration doesn't start to show until about 60 years old.

This patient is 40 years old, and received news of this condition 4 or 5 years earlier. While this has the appearance of macular degeneration, it tends to be less vision threatening. It is very rare. This is probably the third one I've seen in my 15 year optometric career.