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Purpose <p>This study aimed to determine the definitive diagnoses of patients referred to the neuro-ophthalmology unit with a preliminary diagnosis of papilledema, evaluate their clinical and demographic characteristics, and assess the structural and functional parameters of the optic nerve.</p> Methods <p>The medical records of 250 patients referred to the neuro-ophthalmology unit with suspected papilledema were retrospectively reviewed. Patients were classified as having either papilledema or pseudopapilledema. Demographic data, definitive diagnoses, symmetry and grading of papilledema, and optical coherence tomography findings (OCT), including retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) values, were recorded. Visual field parameters, including mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI), were also evaluated.</p> Results <p>Among 250 patients referred for suspected papilledema, 147 (58.8%) were diagnosed with papilledema and 103 (41.2%) with pseudopapilledema. Idiopathic intracranial hypertension was the leading cause (87.8%) in the papilledema group. RNFL thickness in all quadrants was significantly higher in papilledema cases compared to pseudopapilledema (<i>p</i>&lt;0.001). Although average GCC thickness did not differ significantly, papilledema cases had lower values. Visual field analysis revealed significantly worse MD and VFI values in papilledema patients (<i>p</i>&lt;0.01). Headache and transient visual obscurations were more frequent in papilledema, while pseudopapilledema was commonly asymptomatic and often associated with crowded discs or optic disc drusen.</p> Conclusions <p>Differentiating papilledema from pseudopapilledema remains a diagnostic challenge even for ophthalmologists. Accurate identification is essential to avoid unnecessary interventions and anxiety. Combining OCT and visual field analyses enhances diagnostic precision by integrating structural and functional data, supporting timely intervention to prevent irreversible visual loss in true papilledema cases.</p>

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Papilledema suspicion in ophthalmology practice: clinical profiles and structural–functional assessment of the optic nerve in referred cases

  • 期刊论文

  • 发表日期：

    2025年11月6日

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  • Eyupcan Sensoy,
  • Saniye Uke Uzun,
  • Mehmet Emre Ayan

摘要

Purpose

This study aimed to determine the definitive diagnoses of patients referred to the neuro-ophthalmology unit with a preliminary diagnosis of papilledema, evaluate their clinical and demographic characteristics, and assess the structural and functional parameters of the optic nerve.

Methods

The medical records of 250 patients referred to the neuro-ophthalmology unit with suspected papilledema were retrospectively reviewed. Patients were classified as having either papilledema or pseudopapilledema. Demographic data, definitive diagnoses, symmetry and grading of papilledema, and optical coherence tomography findings (OCT), including retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) values, were recorded. Visual field parameters, including mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI), were also evaluated.

Results

Among 250 patients referred for suspected papilledema, 147 (58.8%) were diagnosed with papilledema and 103 (41.2%) with pseudopapilledema. Idiopathic intracranial hypertension was the leading cause (87.8%) in the papilledema group. RNFL thickness in all quadrants was significantly higher in papilledema cases compared to pseudopapilledema (p<0.001). Although average GCC thickness did not differ significantly, papilledema cases had lower values. Visual field analysis revealed significantly worse MD and VFI values in papilledema patients (p<0.01). Headache and transient visual obscurations were more frequent in papilledema, while pseudopapilledema was commonly asymptomatic and often associated with crowded discs or optic disc drusen.

Conclusions

Differentiating papilledema from pseudopapilledema remains a diagnostic challenge even for ophthalmologists. Accurate identification is essential to avoid unnecessary interventions and anxiety. Combining OCT and visual field analyses enhances diagnostic precision by integrating structural and functional data, supporting timely intervention to prevent irreversible visual loss in true papilledema cases.