There was no optic cup in either eye. Spontaneous venous pulsations were absent. The most likely diagnosis is now idiopathic intracranial hypertension. Consultation with a neurologist is often helpful, particularly to obtain a lumbar puncture to establish the diagnosis of elevated intracranial pressure. Papilledema by itself does not require treatment.
Treatment is indicated, however, for visual loss from chronic papilledema or intractable headaches.
Acetazolamide can be given up to 2 grams per day in divided doses. Patients should initially be examined every 2 to 4 weeks. Each examination should include visual acuity, color vision testing, and visual fields to monitor for signs of progression or improvement. If there is a significant threat to visual function, lumboperitoneal shunt or optic nerve sheath fenestration should be considered. Discussion The potentially confusing presentation with this patient is the asymmetry in her optic nerves and visual fields, along with the initially suspected diagnosis of optic neuritis.