This guideline last updated 07/05/2022 10:12:32

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