Indian Journal of Ophthalmology

: 1979  |  Volume : 27  |  Issue : 4  |  Page : 197-

Papilloedema in stages

BD Banerjee 
 Ruby Hall Nursing Home and CGH, Poona, India

Correspondence Address:
B D Banerjee
Ruby Hall Nursing Home and C.G.H., Poona

How to cite this article:
Banerjee B D. Papilloedema in stages.Indian J Ophthalmol 1979;27:197-197

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Banerjee B D. Papilloedema in stages. Indian J Ophthalmol [serial online] 1979 [cited 2020 Nov 30 ];27:197-197
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Full Text

This is a classification of swelling of optic nerve head from all causes with end results and Parsons' papilloedema or Traquair's pleroce­phalic oedema modified in stages. With the advancement of different branches of surgery and medicine there has been a persistant desire to diagnose papilloedema due to intra-cranial causes without heamorrhage of exudates and swelling less than 2D. Papilloedema lost its original meaning since all other swelling other than increased intra-cranial tension are also extended to the diagnosis of clinical entity of papilloedena. Accordingly the terms of `early' `moderate' or `papilloedema present' have lost their original meaning and many other branches of medicine and surgery also examine fundus and treat cases and often there is no co-relation about the diagnosis among them. So the following classification will help to understand the gradual development of swelling of the optic disc and if the stage is mentioned it will be easier for the specialists of different branches to know what exactly has been seen.

Stage I-Haziness and blurring of the disc margins, filling up of the cup, increased redness of the disc, grey radial striations over the disc margins to retina and fullness of veins. Swelling is rarely 2D or less.

Stage II-Few spots of haemmorrhages, spots of exudates turgescene of veins. Swelling is 2D or less.

Stage III-Swelling of disc with haemor­rhages, exudates and distended veins. Swelling is over 2D.

Stage IV-Stage of fibrosis.

Stage V-Post-neuritic optic atrophy.

Stage I has included normal congenital findings in health and abnormal findings in diseases and so Stage I remains often indistin­guishable ophthalmoscopically. To diagnose papilloedema by Stage 1, one should be very cautious unless he has seen the fundus before and should know the embryological development of cup or absence of cup or presence of blurring of disc margin in normal persons since pseudo­papilloedema needs more time consuming through differentiation than neuritis. Corneal microscopic examination with contact lens is much better to exclude uveitis and determine the swelling of the disc. Fluorescein angiography helps to exclude pseudopapilloedema.

The classification also lays more emphasis in the differential diagnosis of pseudo-papilloedema and papilloedema than papilloedema and optic neuritis where diagnosis is comparatively easy with gross functional loss of vision and defective red and green perception.