Synopsis
Confirm true optic-disc swelling from raised intracranial pressure, prioritise safe investigation of secondary causes, and protect visual function while managing idiopathic intracranial hypertension when established.
- Papilloedema specifically means optic-disc swelling due to raised intracranial pressure; not every swollen-looking disc has this cause.
- Early central acuity can remain good despite enlarged blind spots or developing peripheral field loss.
- Confirm the disc findings, measure blood pressure and document acuity, pupils and formal visual fields.
Key red flags
Declining consciousness, a new focal deficit, seizure or rapidly progressive headache with disc swelling requires emergency neurological assessment.
Investigation priorities
Identify severe hypertension and document visual risk accurately.
Management branches
Papilloedema is suspected on examination or accompanied by relevant visual or neurological symptoms.
- Arrange urgent ophthalmic and neurological assessment, documenting blood pressure, vision and any immediate neurological danger signs.
- Obtain appropriate brain and venous imaging before lumbar puncture, escalating immediately rather than using a twenty-four-hour window for a deteriorating patient.
Key medicines
Acetazolamide for specialist-managed IIHThe UK consensus describes a common oral starting regimen of 250–500 mg twice daily, with subsequent clinician-directed titration according to response and tolerance. The optimal dose and treatment duration are not established, so continuation is reviewed against visual findings and adverse effects.