• Lyme Neuroborreliosis Presenting with Isolated Intracranial Hypertension: A Case Report
• Posterior Microphthalmos with Papillomacular Retinal Folds and Pseudo Disc Edema
• Vogt Koyanagi Harada disease with bilateral disc edema diagnosed as Arnold Chiari malformation with papilledema: The blurred margin between ophthalmology and neurology
• The reliability of retinal nerve fiber layer analysis to differentiate between papilledema and pseudopapilledema: A systematic review
• Optic Neuropathies
• Differentiating between mild papilledema and pseudopapilledema on fundus photography
• Eosinophilic Granulomatosis With Polyangiitis Presenting With Neuro-Ophthalmic Manifestations
• Pontine tuberculoma presenting as a true-localising abducens palsy

Papilledema refers to optic disc swelling due to increased intracranial pressure (ICP). However, when optic disc edema is noted, it's crucial to distinguish true papilledema from other causes of disc swelling.

Caused by elevated pressure in the cerebrospinal fluid (CSF):

Intracranial Mass Lesions Tumors (gliomas, metastases, meningiomas)

Abscesses

Hematomas

Cerebral Edema Trauma

Hypoxic-ischemic injury

Hypertensive encephalopathy

Hydrocephalus Obstructive (e.g., aqueductal stenosis)

Communicating (e.g., post-meningitic)

Idiopathic Intracranial Hypertension (IIH) Especially in young obese females

Cerebral Venous Sinus Thrombosis May mimic IIH

Meningitis/Encephalitis Infectious or inflammatory processes causing brain swelling

Unilateral or BilateralOptic Neuritis

Multiple sclerosis

Neuromyelitis optica (NMOSD)

MOG-antibody associated disease

Ischemic Optic Neuropathy

Non-arteritic (NAION): common in elderly, associated with vascular risk

Arteritic (AAION): e.g., giant cell arteritis

Infiltrative or Neoplastic Optic Neuropathy

Lymphoma

Leukemia

Sarcoidosis

Toxic/Nutritional Optic Neuropathy

Methanol, ethambutol

Vitamin B12 deficiency

Congenital Pseudopapilledema

Optic disc drusen

Hypermetropic crowded discs

Other Mimickers

Papillophlebitis (in young patients with retinal vein congestion)

Uveitis (posterior)

Hypertensive retinopathy (Grade IV with disc edema)

Neuroimaging: MRI/MRV to rule out mass lesion, thrombosis

Lumbar Puncture: Measure opening pressure, CSF analysis (after imaging)

OCT: Assess retinal nerve fiber layer thickness

Visual fields: Enlargement of blind spot common in papilledema

Fundus autofluorescence/ultrasound: To detect optic disc drusen

A comprehensive review_article by Susan P. Mollan offers a timely update on the diagnosis and management of papilledema, a condition characterized by bilateral optic disc swelling due to raised intracranial pressure. The article is particularly relevant in the context of increasing cases of idiopathic intracranial hypertension (IIH), strongly correlated with the global rise in obesity ¹⁾

A standout strength of this review lies in its emphasis on differentiating true papilledema from pseudopapilledema, a common diagnostic pitfall. The discussion on the role of optical coherence tomography (OCT) is especially valuable. The inclusion of recent imaging biomarkers and structural OCT changes improves clinical accuracy in distinguishing optic disc edema from congenital anomalies like buried optic nerve head drusen.

The article also highlights the multidisciplinary nature of papilledema care. Effective management relies on collaboration between ophthalmologists and neurologists, with shared responsibilities in both diagnosis and treatment—especially crucial when symptoms such as visual field defects and chronic headache are present.

However, the review could have benefitted from a more in-depth exploration of emerging therapies for cerebrospinal fluid (CSF) regulation. Although newer treatment pathways are mentioned, details on pharmacologic or surgical innovations are limited. Further commentary on the role of neuroimaging advancements, particularly with high-resolution MRV (magnetic resonance venography), would have added a more complete clinical picture.

In conclusion, this article is an essential read for any clinician managing patients with suspected raised intracranial pressure. It combines updated diagnostic strategies with practical insights into team-based care, although it leaves room for more discussion on therapeutic frontiers.

Difficulties occur in the differential diagnosis of papilledema against similar changes of the optic nerve head seen during ophthalmoscopy ²⁾

Causes of papilledema include intracranial tumors, idiopathic intracranial hypertension (pseudotumor cerebri), subarachnoid hemorrhage, subdural hematoma and intracranial inflammation. Optic disc edema may also occur from many conditions other than papilledema, including central retinal artery or vein occlusion, congenital structural anomalies, and optic neuritis ³⁾.