The papillary excavation

definition

The papilla excavation is the deepening of the so-called optic nerve papilla. The papilla is the point on the eye where the optic nerve enters the eyeball. There is no retina at this point, so this part of the eye is not required for active vision. However, it is a weak point in the eyeball, as there is a gap in all of the stabilizing layers that surround the eyeball. Therefore, changes in the eye can quickly affect the tissue on the optic nerve papilla.

This is especially the case when there is increased pressure in the eye. The pressure in the eye pushes the optic nerve slightly outwards, creating a depression - the so-called papillary excavation.

The reasons

Classically, glaucoma is the most common cause of papillary excavation. This results in increased pressure in the eye, which can be relieved a little at the point of the papilla by pressing the optic nerve papilla slightly outwards.

Normally the papilla has a small natural excavation, only if this is particularly pronounced (for example due to the pressure) is it called a pathological papillary excavation. Other diseases can also cause papillary excavation. These include, for example, inflammation in the eye such as uveitis, which is also associated with increased intraocular pressure. One of the congenital diseases with papillary excavation is coloboma (a defect in the iris).

Glaucoma as the cause

Glaucoma, also known as glaucoma, is a disease that causes increased pressure in the eye. A distinction is made between an acute attack of glaucoma and chronic glaucoma. During an acute attack, the chamber angle (the point where fluid is filtered out of the eye) can become blocked, causing a sudden increase in pressure from too much fluid

Due to the increased pressure inside the eye, the optic nerve papilla is pressed outwards, causing an excavation of the papillae. Typical symptoms are visual disturbances and restrictions of the visual field. In the case of an acute attack of glaucoma, other complaints such as eye pain and headache as well as a reddened eye and a very hard eyeball can occur. Chronic glaucoma, on the other hand, is often very symptom-free because it progresses slowly and the body adapts to the changed conditions in the eye.

Find out more about the topic here: The glaucoma.

The excavation without the cause of glaucoma

Excavation of the papilla does not always have to be associated with glaucoma. There are also other diseases that are associated with increased intraocular pressure and thereby trigger papillary excavation. These include, for example, inflammatory diseases of the eye, which also lead to an increased accumulation of fluid and cells in the eye and thus increase the pressure.

However, diseases outside the eye can occasionally cause papillary excavation. For example, pulling the optic nerve can result in an excavation of the papilla. The cause of this often lies in the brain.

Find out more about the here Inflammation of the eye.

Congenital papillary excavation as the cause

A papilla excavation can occasionally already exist from birth. In this case one speaks of an innate excavation. The change in the structure of the optic nerve papilla does not necessarily go hand in hand with a disease. For example, it can be a slight malformation of the eye that does not cause any symptoms. The eyesight does not have to be restricted either. Especially if the papillary excavation does not change and there are no symptoms, a harmless event can be assumed. Nevertheless, regular checks of the papilla excavation should be carried out.

Another cause of congenital papillary excavation is congenital glaucoma, which is associated with increased eye pressure. This is a disease of the eye that should be treated as quickly as possible so that as few visual impairments as possible remain.

The accompanying symptoms

Symptoms that accompany papillary excavation depend on the underlying cause. Since most changes in the papillae are caused by glaucoma, these symptoms should be given priority. An acute glaucoma attack is often accompanied by sudden headache and eye pain. Redness of the affected eye and impaired vision can occur. The pupil can also be changed (for example, somewhat widened and rounded). Occasionally, symptoms such as vomiting, nausea, and dizziness from the increased pressure will also occur.

Chronic glaucoma is usually only accompanied by unspecific symptoms such as burning eyes and headaches. Visual field defects can also occur here; these are usually small at first and progress slowly, so that they are often not noticed immediately.

Even if the papillary excavation is not caused by glaucoma, visual disturbances usually occur as accompanying symptoms. Headaches, dizziness and a reddened eye are also often associated with the papilla excavation.

The symptoms of glaucoma? Read on here.

The diagnosis

The diagnosis of papillary excavation begins with the anamnesis, i.e. questioning the person concerned. Often, visual disturbances or other eye complaints are the cause of the doctor's visit. In the case of an acute attack of glaucoma as the cause of the papilla excavation, symptoms such as a very hard palpable eyeball or a reddened eye can also occur.

If a papillary excavation is suspected, an ophthalmoscopy should then be performed. This is the reflection of the fundus, in which the optic nerve papilla can also be viewed. The change in shape of the papilla can be seen particularly well from the course of the blood vessels. If glaucoma is suspected, intraocular pressure can also be measured. The examination of the visual field can also provide further information.

The treatment

Treatment for papillary excavation depends on its cause. The most common cause of papillary excavation is glaucoma. When treating glaucoma, a distinction must be made between acute (emergency) glaucoma and chronically increased intraocular pressure.

The acute glaucoma attack must be treated as quickly as possible. The treatment consists of a drug-based lowering of the intraocular pressure, a reduction in the new production of aqueous humor and an exposure of the blocked chamber angle. If necessary - if drug therapy is not sufficient - the chamber angle must be surgically exposed so that fluid can flow out of the eye again. In chronic glaucoma, the intraocular pressure is usually adjusted with medication.

Inflammatory causes of an excavation of the papillae are treated in many cases with painkillers that also have an anti-inflammatory effect. Cortisone can also be used in the treatment of inflammatory eye diseases, and drugs that downregulate the immune system may also have to be used. If a pathogen plays a role in an infectious eye disease, antibiotics or drugs against certain eye viruses can also be used.

This article might also interest you: The operation of glaucoma.

The duration

How long a papillary excavation lasts also depends on the cause of the disease. Acute illnesses have to be treated as quickly as possible, after which the excavation of the optic nerve papilla disappears quickly.

In the case of chronic disease occurrences, an excavation of the papillae can be present for several months or even for years.

Congenital papillary excavations, if they have no disease value - that is, they are not accompanied by complaints and impaired vision - can even remain lifelong without having to be treated.

The consequences of a papilla excavation

The consequences of an excavation of the papilla vary greatly depending on the underlying cause. While a congenital excavation of the papilla may not have any consequences, it can also be caused by congenital glaucoma, which must be treated surgically immediately and is still usually associated with permanent visual disturbances.

Likewise, glaucoma attacks can lead to permanent visual disturbances and restrictions of the visual field. In the case of inflammatory diseases, other structures of the eye can also be affected, so that adhesions and visual disturbances can occur in the affected eye.