Walsh & Hoyt: Papilledema: Diagnosis

The most important method of diagnosing papilledema is careful ophthalmoscopic examination, assessing the features described above. An examination that includes red-free ophthalmoscopy and slit lamp biomicroscopy with a handheld or contact lens is usually sufficient to determine whether papilledema is present. If the diagnosis remains uncertain several options are available. Fluorescein angiography is often used to confirm early papilledema. The test itself is easily performed in an outpatient setting: 5 ml of 10% fluorescein sodium are rapidly injected into a superficial arm vein. Alternatively fluorescein can be given orally. The passage of dye through retinal vessels is then observed and photographed at rapid intervals, with a cobalt blue filter interposed in front of the light source to visualize the fluorescence of the dye. Even if photographic facilities are lacking, the examiner can observe the ocular fundus using an indirect ophthalmoscope or a slit lamp with a handheld or contact lens with the correct filter in place.