Walsh & Hoyt: Unilateral or Asymmetric Papilledema

Papilledema is usually bilateral and relatively symmetric in the two eyes. In some instances, it is strictly unilateral or at least much more pronounced in one eye than in the other. Some patients may have had preexisting atrophy before the development of increased ICP (the pseudo-Foster Kennedy syndrome; see belowand in Chapter 4). If there are not enough viable nerve fibers, papilledema cannot occur (dead axons dont swell). However, if sufficient nerve fibers remain, papilledema may develop even though the optic disc is pale.