Failure to Diagnose Papiledema

Failure to Refer for Brain CT

Papilledema is swelling of the optic disk due to increased intracranial pressure. Because of the serious nature of this condition, and the ability to detect pailedema in an eye exam by an ophthalmologist or optometrist, the diagnosis of papilledema requires an immediate referral to the ER to identify the cause.

Failure to refer the patient with suspected papiledema, or after diagnosing papiledema, to the local Emergency Department for emergency brain CT or brain scan, may be grounds for a medical malpractice claim against the ophthalmologist or optometrist.

Diagnosis of papiledema is made by ophthalmoscopy.  The cause may be identified through further tests, usually brain imaging performed at a hospital.

Papilledema is a sign of elevated intracranial pressure and almost always affects both eyes.

Causes of Papiledema include the following:

• brain tumor
• brain abscess
• cerebral trauma
• cerebral hemorrhage
• meningitis
• arachnoidal adhesions
• cavernous thrombosis
• dural sinus thrombosis
• encephalitis
• idiopathic intracranial hypertension (pseudotumor cerebri)
• • this condition involves elevated Cerebral Spinal Fluid (CSF) pressure and no mass lesion

Detection of Papiledema By an Eye Doctor (Optometrist or Ophthalmologist)

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.

Ophthalmoscopic examination then reveals engorged retinal veins, a swollen optic disk (optic nerve head), and retinal hemorrhages/bleeding.

Isolated optic disk swelling (e.g. caused by optic neuritis, ischemic optic neuropathy) without elevated CSF pressure is not considered papilledema.

Papilledema

In the early stages, vision and the pupils' response to light are usually normal and become abnormal only after the condition is well advanced. An enlarged blind spot may be detected on visual field testing. Later, nerve fiber bundle defects may be apparent.

Once the eye exam has been performed, and the diagnosis of papiledema has been made, the eye doctor must refer the patient for immediate neuroimaging, such as a brain CT.  The fastest way to achieve this emergency scan is through an Emergency Department.

The degree of optic disk swelling can be quantified by comparing the plus lens numbers needed to focus an ophthalmoscope on the most elevated portion of the disk and on the unaffected portion of the retina.

Differentiating papilledema from other causes of a swollen optic disk, such as optic neuritis, ischemic optic neuropathy, hypotony, central retinal vein occlusion, uveitis, or pseudo swollen disks (eg, optic nerve drusen), requires a thorough ophthalmologic evaluation.

If papilledema is suspected during the eye exam, then referral for MRI with contrast is done immediately to exclude causes such as an intracranial mass.

Urgent treatment of the underlying disorder is needed to decrease intracranial pressure. If intracranial pressure is not reduced, that pressure leads to optic nerve atrophy and vision loss.

Failure to timely diagnose papiledema, and emergent referral to ER for scans and testing to identify the cause so proper treatment can be administered, can be a form or ophthalmogist malpractice or optometrist malpractice.

Papiledema is often a sign of a serious, even terminal, underlying condition.  Failure to aggresively identify and treat the condition may result in blindness as well as death from the underlying cause.  Additionally, the pressure can cause optic neuropathy which may lead to blindness.

Ophthalmology Malpractice

Optometry Malpractice

Misdiagnosis of Papiledema

Failure to Refer for Brain CT

If you have been the victim of malpractice because of an eye doctor's failure to diagnose retinal detachment, and suffered blindness or permanent vision loss, then contact our office for an immediate, confidential, consultation.