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