How do you work up incidentally found papilledema in the emergency room?

The term "papilledema" should be reserved for optic disc swelling due to increased intracranial pressure - but I assume that this question is asking what to do if the fundus examination looks abnormal (blurred disc margins perhaps) when there are no visual symptoms or symptoms of increased intracranial pressure (i.e., no complaints of blurred vision or headache).

The first step should be to assess the patient's vision. I would want to look for any evidence of visual dysfunction (even in the abse...

Are you sure it's papilledema?

If my experience at the university primary teaching hospital (lacking an ophthalmology dept.) is representative, most "incidentally found papilledema" in the ER is a direct referral from an ophthalmologist, filling the void created by the "demise of direct ophthalmoscopy" among students, residents, and faculty. In fact, many students don't purchase what would become a $600 Welch-Allyn "paperweight". ERs routinely call upon our neurology residents, not because of op...