Identifying papilloedema and management of IIH: are we adhering to the IIH consensus guidelines?

<h3></h3> Papilloedema is optic disc swelling due to raised intracranial pressure. If no cause is found, idiopathic intracranial hypertension (IIH) is diagnosed. Within Lancashire, no pathway currently exists to investigate suspected papilloedema or manage IIH patients. The aim was to compare current regional practice to the 2018 IIH consensus guidelines. Data was collected from electronic patient records between 01/01/21 to 31/12/21. Sites included were Lancashire Teaching Hospitals Foundation Trust, Blackpool Victoria Hospital, Royal Blackburn Hospital and Royal Lancaster Infirmary. From 53 patients identified, 25 had suspected papilloedema while 30 had established IIH. The mean age was 30 years, 48 were female and 8 were paediatric. Before referring to Neurology for suspected IIH, 20% had no fundal examination and 24% had no documented visual assessments. 68% had no venogram with 12% having no imaging at all. Only 16% had a successful LP. However, 84% had appropriate follow-up. When referring for management of established IIH, 53% had not confirmed papilloedema presence but 68% saw Ophthalmology within 72 hours of admission. 23% had a LP without confirming papilloedema. Only 28% of headaches were phenotyped with 39% given opiate- based medications. 96% did not enquire about medication overuse headache. 22% documented giving appropriate weight advice. Regional guidelines and pathway are required to improve the investigation and management of suspected papilloedema and established IIH.