In cases of optic neuropathy due to inflammation, infiltration, ischemia or demyelinization, visual acuity is often significantly diminished. Papilledema, a specific form of disc edema resulting from elevated intracranial pressure, generally exhibits a minimal acuity deficit, but may demonstrate transient visual obscurations associated with postural changes. Visual field defects vary widely as well. In general, you may observe an enlarged physiologic blind spot in any form of disc edema which displaces the peripapillary photoreceptors.
Arcuate scotomas are also common when the inferior and superior poles of the disc are compromised.
If disc swelling is unilateral and vision is poor, expect to find a relative afferent pupillary defect in the involved eye. True bilateral papilledema will not present with an afferent pupillary defect. The earliest signs of disc edema include striations within the nerve fiber layer in conjunction with blurring of the superior and inferior margins of the neural rim tissue. The disc itself will, in time, protrude from the retinal surface. In cases of inflammation or papilledema, it may display hyperemia and capillary dilation.