Date of last review: Due to be updated

Differential diagnosis

  • Congenitally crowded discs
  • Optic disc drusen
  • Tilted optic discs
  • Peripapillary myelinated nerve fibres

Possible management by Optometrist

Treatment

  • None

Advice

  • Can be hard to differentiate papilloedema from pseudopapilloedema
    • Only look for papilloedema if patient's symptoms suggestive of raised intracranial pressure
      • Whooshing noise in ears (often present with idiopathic intracranial hypertension)
      • Increasing severity and frequency of headache
      • Headache worse on leaning forwards
      • Headache wakes patient
      • Vomiting, especially in absence of nausea
    • Use retinal photography instead of slit lamp examination
      • Optical coherence tomography cannot separate papilloedema from pseudopapilledema,
      • Do not use optical coherence tomography for diagnosis
        • Optical coherence tomography may have a role in monitoring, but serial photography often easier to interpret
    • Brain tumours rarely present with headache alone
      • They present with fits, atypical stroke, confusion or other neurological symptoms
    • Urgent CT head/venogram scan is only required if vision affected (rare) or neurological signs present
    • CT head scan within seven days is adequate for most
  • Urgent referral if symptoms of raised intracranial pressure present
    • Headaches - worse in the morning, exacerbated by coughing/straining, or changing posture
    • Nausea and/or vomiting
  • Semi-urgent referral otherwise

Management Category

  • Urgent referral, if symptomatic, with images, to ophthalmology
  • Semi-urgent referral, if asymptomatic, with images, to ophthalmology

Possible management by Ophthalmologist

  • Observation
  • CT venogram to rule out space occupying lesion and cerebral venous thrombosis
  • Lumbar puncture
  • Referral to neurology
  • Referral to neurosurgery