A 30-year-old woman presents with new onset headaches and blurry vision

The image is consistent with optic disc edema. When this is due to increased intracranial pressure, it is called papilledema.

• Papilledema occurs when increased intracranial pressure (from any etiology) leads to optic nerve swelling.
• This can be idiopathic, due to intracranial masses or changes in cerebral spinal fluid (CSF) volume balance.
• Papilledema is usually bilateral, and swelling can be identified on fundoscopic examination.

• Perform a careful history and physical examination: evaluate risk factors, associated symptoms, and any neurologic deficits.
• Perform a direct ophthalmoscopy to check for optic disc edema.
• Refer to the emergency department (ED) immediately (or consult ophthalmology if already in the ED).
• Papilledema is an emergency: a delay in diagnosis and treatment could lead to permanent vision loss (or death, depending on the underlying cause).

• Neuro-ophthalmologic imaging and evaluation to rule out other diagnoses
• Careful fundoscopic examination to categorize the severity of optic nerve swelling and track visual deficits over time
• Management and follow-up dictated by acuity

• Intracranial mass: resection, other appropriate measures
• Idiopathic: weight loss, acetazolamide, avoiding precipitating substances, managing other chronic conditions 
  • CSF shunting or optic nerve sheath fenestration if conservative measures unsuccessful

• Sudden Vision Loss – AAO Interactive Case
• Approach to Acute Vision Loss in the Emergency Department (AAO Medical Knowledge Video)
• Ocular Manifestations of Increased Intracranial Pressure (AAO Medical Knowledge Video)
• Optic Neuropathies (AAO Medical Knowledge Video)
• Careers in Ophthalmology