Arteritic ischemic optic neuropathy in giant cell arteritis, but patient usually has systemic symptoms
Optic neuritis, but patient reports acute vision loss and sometimes periocular pain in affected eye on gaze from side to side
Compressive optic neuropathy from mass in orbit or optic canal, but lesion visible on imaging
Infiltrative optic neuropathy from metastatic cancer or systemic inflammation like sarcoidosis, but there is usually evidence of cancer or inflammation elsewhere
Leber hereditary optic neuropathy, but usually unilateral and optic disc is hyperemic
Refer emergently (within 24 hours) to ophthalmologist if you detect elevated optic discs and patient has visual, neurologic, or constitutional symptoms
Refer urgently (within 48 hours) if you detect elevated optic discs in an asymptomatic patient
Ophthalmologist will try to determine cause of elevated optic disc
If papilledema is suspected, patient will undergo immediate neurologic examination and brain imaging
If arteritic ischemic optic neuropathy is suspected, patient will undergo prompt intensive corticosteroid treatment and temporal artery biopsy
If compressive optic neuropathy is suspected, patient will undergo orbit and brain imaging
If infiltrative optic neuropathy is suspected, patient will undergo orbit/brain imaging, lumbar puncture, and search for evidence of metastatic cancer or systemic inflammation
If Leber optic neuropathy is suspected, patient will undergo blood testing for appropriate mitochondrial gene mutations
Undiagnosed chronic papilledema may lead to death of optic nerve axons and dreadful and irreversible vision loss, therefore...
Early detection of papilledema is critical, not only to discover and treat its cause, but to relieve pressure on optic nerves