Papilloedema (optic nerve or disc swelling)
Disclaimer
These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.
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Referral to Emergency Department:
If any of the following are present or suspected, please refer the patient to the Emergency Department (via ambulance if necessary) or seek emergency medical advice if in a remote region.
- Papilloedema, with headache, visual changes (e.g., diplopia), pulsatile tinnitus, or focal neurological signs
- Papilloedema, with systemic illness (fever, neck stiffness, vomiting, confusion, drowsiness)
- Suspected retinal haemorrhage or exudate
- Sudden vision loss
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Introduction
Swelling of the optic nerve, primarily caused by increased intracranial pressure.
Pre-referral investigations
Pre-referral management
When to refer
Refer to the Ophthalmology Department
New finding of papilloedema without concerning features or clinical symptoms associated.
How to refer
- Routine non-urgent referrals from a GP or a Consultant are made via the Central Referral Service
- Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals are made via the PCH Referral Office (Fax: 6456 0097 or email PCH.Referrals@health.wa.gov.au)
- Urgent referrals (less than seven days) are made via the PCH Referral Office. Please call Perth Children’s Hospital Switch on 6456 2222 to discuss referral with the relevant speciality registrar.
Essential information to include in your referral
History
- Relevant history, including description of how a finding of papilloedema has been made (i.e. formal reports, fundoscopy etc.)
- Current medication list
- Any known allergies
Examination
- Neurological examination results
Useful resources
- Royal Children’s Hospital Melbourne Clinical Practice Guideline: Eye Examination
| Reviewer/Team: |
Ophthalmology Department, PCH |
Last reviewed: |
May 2026 |
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