Rising consultations for suspected papilledema: clinical and neuro-ophthalmologic insights

Abstract

Purpose: To determine the prevalence of papilledema among patients referred for suspected papilledema and identify symptoms associated with increased intracranial pressure.

Methods: This retrospective study included 514 patients referred to the ophthalmology clinic with suspected papilledema. Patient records were reviewed for demographic details, symptoms, and diagnostic outcomes. Examinations included best-corrected visual acuity (BCVA) assessments, fundoscopic evaluations, visual field (VF) tests, optical coherence tomography (OCT)-retinal nerve fiber layer (RNFL) thickness and fundus photographs. The rates of detected papilledema and pseudopapilledema, along with associated symptoms, were evaluated.

Results: Of 514 patients, papilledema was diagnosed in 109 cases (21.2%). Idiopathic intracranial hypertension was the most common etiology (n = 91), yet cases with serious underlying causes, such as intracranial tumors (n = 5) and cerebral venous sinus thrombosis (n = 5), were also identified. Headache was a frequent symptom but showed no significant correlation with papilledema (p = 0.653), while transient visual obscurations (TVOs) demonstrated a strong association (p < 0.001). Among papilledema patients, 33 had full BCVA, and 37 had a VF MD of - 2 dB or better. Abnormal VF (MD worse than - 2 dB) was found in 36.4% of patients with full BCVA. It was observed that the RNFL thickness in all quadrants was greater in the papilledema group compared to the healthy optic disc group. Pseudopapilledema, present in 20 patients (3.9%), was frequently due to optic disc drusen. There were no statistically significant differences in symptoms between patients with papilledema and those with pseudopapilledema.

Conclusion: Papilledema screening is a common consultation, particularly in the presence of accompanying symptoms, and accurate evaluation is crucial, especially for patients presenting with TVOs. Abnormal VFs were detected in patients with normal BCVA, most commonly presenting as an enlarged blind spot. This highlights that BCVA alone is insufficient for diagnosing and monitoring suspected papilledema. Recognizing papilledema is vital given its association with conditions carrying significant morbidity and mortality risks, such as intracranial tumors and thrombosis. Enhanced ophthalmoscopy skills among referring physicians may streamline the referral process, reduce unnecessary consultations, and improve patient outcomes by enabling timely intervention for high-risk cases.

Keywords: Headache; IIH; Papilledema; Pseudopapilledema; Transient visual obscurations; İdiopathic intracranial hypertension.