Q. Can papilledema occur bilaterally?

Answered by
Dr. Rahul Vaswani
and medically reviewed by Dr.Nithila A
This is a premium question & answer published on Apr 25, 2019

Hello doctor,

I have elevated optic disc with blurred edges only in the left eye, that was discovered on routine eye examination. I have developed headaches in the last few weeks. If this was papilledema would it be bilateral?



Welcome to

Papilloedema is always bilateral. It is due to increased pressure in the brain. If it is unilateral, it is called papillitis, that is due to underlying inflammation.

Thank you doctor,

I forgot to mention that last week I had a very painful left temple, and it felt bruised to touch. I do not have any pain in my eyes or blurred vision. I do occasionally get floaters. I am concerned more for my headaches that I get always left side, and that is the eye where the elevated optic discs were.



Welcome back to

Seeing your symptoms. I will advise you to get,

1. An MRI of orbit and brain.

2. V.E.P (Visual evoked potential test).

3. Dilated fundus examination.

4. ESR of your blood test (erythrocyte sedimentation rate).

We have to rule out optic neuritis, and other causes of disc inflammation. Tell me when there is pain does your vision goes down? Is there a history of smoking? Did you have a recent history of viral illness or fever?.

Thank you doctor,

I have absolutely no problems with vision apart from floaters. I smoked when I was about 16 until the age of 21 but, I have not smoked at all in the last four years. I have not been unwell or had any viral illnesses in the recent months.

I had a blood test, and the doctor ruled out that there is inflammation. I do believe the doctor checked my eyes with lights for checking dilation and also had some eye scan. I think it was OCT but not sure.



Welcome back to

I strongly suggest you to see a neurophysician to get these tests done. Also rule out cat scratch disease and Lyme disease. According to your symptoms and history, it is either optic neuritis or neuroretinitis. But, it has to be confirmed by these tests. If OCT (optical coherence tomography) were done, then I would like to see the images.

Thank you doctor,

If It was any of those conditions would I not have pain in the eye? I have never had pain the eye or any pain when I make eye movements. Just pain in a left temple but I do not have that pain now.

I was concerned it was swelling from the brain, but that will it affect both eyes? I have seen many doctors recently I have been to them about headaches, and they all keep telling me it is nothing to worry about.



Welcome to

Temporal associated headache with blurred disc margins is reason enough to investigate you for the causes mentioned above. I still advise you to see a neurophysician to rule out any other causes. If none of the tests come positive, we can give a steroid trial for this to resolve.

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