The clinical features and progression of papilledema are variable, and are influenced by factors including the rate of increase and severity of raised intracranial pressure (ICP), age and pre-existing ocular pathology. In general, however, papilledema has been observed to evolve through several stages, with a variety of potential sequelae (see table).

Figure 1.

Papilledema with A hyperemic disc swelling,venous congestion and B macular star.

Figure 2.

Same patient, J 3  months later, showing chorioretinal folds and pale,K atrophic, optic disc.

Early (several days after the appearance of ICP)

  • Raised ICP is transmitted through the optic nerve sheath, compressing nerve fibers
  • Transient visual obscurations
  • Headache, nausea & vomiting due to raised ICP
  • Altered conscious state, esp. with severe or sudden raised ICP
  • Diplopia from 6th cranial nerve palsy
  • Disc hyperemia, with mild elevation and blurring of disc margins
  • Visual acuity is seldom affected
Established (weeks)

  • Disc swelling and elevation usually develop over several days to weeks
  • As with early papilledema
  • Symptom progression may lead to persistent blurring of vision & blind spot enlargement
  • Enlarged optic disc with blurred margins
  • Dilated retinal veins, peripapillary haemorrhages and cotton-wool spots
  • Edema: circumferential retinal folds
  • Reduced acuity uncommon with serious prognosis
Chronic (weeks to months)
  • Progressive blurring of vision & blind spot enlargement (variable)
  • ‘Champagne-cork’ appearance to optic disc
  • Tortuous capillaries on the optic disc
  • Crystalline deposits may be develop on the disc surface
  • Macular edema leading to macular star
  • Retinal pigment epithelium (RPE) detachment
  • Nerve fiber dropout results in progressive reduction of visual fields and acuity
Atrophic (months to years)

  • Ischemic nerve fiber atrophy with chronic disc swelling
  • Permanent visual loss (variable)
  • Optic disc pallor, with indistinct margins
  • Visual field loss usually precedes visual acuity loss
  • Rarely, subretinal neovascular membranes form and may bleed, leading to acute loss of vision


Papilledema – Diagnosis, Chorioretinal Folds & Retinal Folds, Cotton Wool Spots, RPE Detachment.

Papilledema – Evolution & Sequelae