Papilledema Treatment & Management

Updated: Dec 01, 2017
  • Author: Mitchell V Gossman, MD; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Medical Care

Therapy, whether medical or surgical, is tailored to the underlying pathological process and the progression of the ocular findings.

Specific therapy should be directed to the underlying mass lesion if present.

Patients should sleep with the head of the bed elevated. Sleep apnea, if present, should be treated.

Diuretics: The carbonic anhydrase inhibitor, acetazolamide (Diamox), may be useful in selected cases, especially cases of idiopathic intracranial hypertension. (In the presence of venous sinus thrombosis, diuretics are a relative contraindication. In this scenario, evaluation by a hematologist is recommended.)

Weight reduction is recommended in cases of idiopathic intracranial hypertension and can be curative. [8] Bariatric surgery may be considered in cases refractory to conventional methods of weight loss. [9]

Corticosteroids may be effective in cases associated with inflammatory disorders (eg, sarcoidosis).

Consider withdrawing causative medications, as weighed against other medical necessities and alternatives.


Surgical Care

The underlying mass lesion, if present, should be removed.

Lumboperitoneal shunt or ventriculoperitoneal shunt can be used to bypass CSF.

Optic nerve sheath decompression can be used to relieve worsening ocular symptoms in cases of medically uncontrolled idiopathic intracranial hypertension. This procedure probably will not ameliorate persistent headaches if present.



Besides an ophthalmologist, a neurologist should be involved in monitoring the patient, and a neurosurgeon may be needed to help evaluate any underlying mass or to perform a shunting procedure.



Dietary restrictions and consultation with a dietitian in case of idiopathic intracranial hypertension is recommended.


Long-Term Monitoring

The patient should be examined weekly until stabilization of the ocular findings occurs. Well-developed papilledema takes 6-10 weeks to regress, following lowering of intracranial pressure.