Management
The College of Optometrists recommends that papilloedema or
suspected papilloedema should be referred to an ophthalmologist
as an emergency, within 24 hours of diagnosis. 23
It carries with it a risk of loss of life as well as loss of vision. Once
papilloedema has been confirmed by an Ophthalmologist, patients will
be investigated by a neurologist to try to diagnose the underlying cause.
Typical investigations include Neuroimaging such as CT or MRI, usually with
intravenous contrast. Patients may require a lumbar puncture to measure
CSF pressure. Depending on the cause patients may require surgery to
remove a space occupying lesion or CSF obstruction. Carbonic anhydrase
inhibitors, such as acetazolamide, can provide symptomatic relief of raised
intracranial pressure and obese patients with idiopathic IH will be advised
to lose weight. Ongoing headaches can be managed pharmacologically
with amitriptyline or other migraine prophylactic agents. 24
Figure 7 - MRI scan of an eye with
papilloedema due to intracranial
hypertension. Case courtesy of A.Prof
Frank Gaillard, Radiopaedia.org, rID: 2640
Complete a short multiple choice test at www.cetpoints.com to earn 1 CET point.
References
All URLs accessed October 2016
In focus: Optometry must reflect on manslaughter verdict,
Simon Jones, Optician, 22 July 2016.
https://www.opticianonline.net/features/honey-rose-verdict
1
The law must recognise that medicine isn’t perfect and neither
are our doctors, Ross Clark, The Spectator Coffee House Blog,
10 September 2015. http://blogs.spectator.co.uk/2015/09/the-
law-must-recognise-that-medicine-isnt-perfect-and-neither-are-
our-doctors/
2
Open letter to the Academy of Medical Royal Colleges
& Department of Justice on the use of Gross Negligence
Manslaughter, Dr David Nicholl, 21 July 2016. https://www.
gopetition.com/petitions/open-letter-to-the-academy-of-
medical-royal-colleges-department-of-justice-on-the-use-of-gross-
negligence-manslaughter.html#.V5EoY45CIUw.twitter
3
Standards of Practice for Optometrists and Dispensing Opticians,
General Optical Council 2016. https://www.optical.org/en/
Standards/Standards_for_optometrists_dispensing_opticians.cfm
4
Sight testing (examination and prescription) (no 2) regulations
1989. Section 3(1)(a). https://www.optical.org/en/about_us/
legislation/rules_and_regulations.cfm
5
The rules relating to injury or disease of the eye 1999. Section
6. https://www.optical.org/en/about_us/legislation/rules_and_
regulations.cfm
6
Increasing demand on hospital eye services risks patients losing
vision, The Royal College of Ophthalmologists, 16 March 2016.
https://www.rcophth.ac.uk/2016/03/increasing-demand-on-
hospital-eye-services-risks-patients-losing-vision/
7
Criminal Trial Of Optom, Association of optometrists, 13 July
2016. https://www.aop.org.uk/ot/professional-support/clinical-
and-regulatory/criminal-trial-of-optometrist-begins
8
General Optical Council v Jeremiah Michael Francis Kelly (01-
23549), Determination Of A Substantive Hearing, 22-26 February
And 7-8 July 2016. https://www.optical.org/en/Investigating_
complaints/Hearings/past_hearings/index.cfm
9
General Optical Council v Prem Earth Pal Singh Kora (01-16239),
Determination Of A Substantive Hearing, 12-13 July 2016.
https://www.optical.org/en/Investigating_complaints/Hearings/
past_hearings/index.cfm
10
General Optical Council v Benjamin Hing (01-20939),
Determination Of A Substantive Hearing, 19-23 September 2016.
https://www.optical.org/en/Investigating_complaints/Hearings/
past_hearings/index.cfm
12
Criminal Trial Of Optom, Association of optometrists, 5 July
2016. https://www.aop.org.uk/ot/professional-support/clinical-
and-regulatory/criminal-trial-of-optometrist-begins
13
General Optical Council Annual Report 2014-2015
14
Fitzgibbon EJ, Lee AG, Jirawuthiworavong GV, Papilledema,
American Academy of Ophthalmology EyeWiki. February 2015.
http://eyewiki.aao.org/Papilledema
15
Brain 101:The Ventricles and CSF Flow, Karima Roumila,
Hydrocephalus Association. http://www.hydroassoc.org/brain-
101-the-ventricles-and-csf-flow/
16
Friedman DI, Jacobson DM, Diagnostic criteria for idiopathic
intracranial hypertension. Neurology 2002 59: 1492-1495
17
Caballero B. The global epidemic of obesity: an overview.
Epidemiol Rev 2007;29:1–5.
18
Gans MS, Lee GL. Idiopathic Intracranial Hypertension. Medscape
emedicine. http://emedicine.medscape.com/article/1214410-
overview#a1
19
Intracranial Hypertension, NHS Choices. http://www.nhs.
uk/conditions/intracranial-hypertension/Pages/Introduction.
aspx#symptoms
20
Killer HE, Jaggi GP, Miller NR; Papilledema revisited: is its
pathophysiology really understood? Clin Experiment Ophthalmol.
2009 Jul;37(5):444-7.
21
Mollan SP, Sinclair AJ et al. A practical approach to,
diagnosis, assessment and management of idiopathic
intracranial hypertension. Pract Neurol doi:10.1136/
practneurol-2014-000821.
22
C171 Urgency of Referrals, College of Optometrists Clinica l
Guidance. http://guidance.college-optometrists.org/guidance-
contents/communication-partnership-and-teamwork-domain/
working-with-colleagues/urgency-of-referrals/
23
Silberstein SD, Ben-Menachem E, Shank RP, et al. Topiramate
monotherapy in epilepsy and migraineprevention. Clin Ther
2005;27:154–65.
24
General Optical Council v Simon Betney (01-15180),
Determination Of A Substantive Hearing, 12-16 September 2016.
https://www.optical.org/en/Investigating_complaints/Hearings/
past_hearings/index.cfm
11
November 2016 | etCETera
17