Refractory Papilloedema Secondary to Idiopathic Intracranial Hypertension: Successful Treatment with Optic Nerve Sheath Fenestration

Idiopathic intracranial hypertension (IIH) is marked by elevated intracranial pressure (ICP) without a known cause, often leading to papilloedema and potential vision loss.The authors present a case of refractory IIH-associated papilloedema treated with optic nerve sheath fenestration (ONSF).The patient initially presented with headache and vision loss consistent with IIH, with bilateral papilloedema noted on examination.Despite medical management, including medications and lumbar drainage, papilloedema persisted, worsening visual symptoms.Due to its refractory nature, the patient underwent bilateral ONSF performed by the ENT team.This involved creating small fenestrations in the optic nerve sheath to allow cerebrospinal fluid drainage and reduce ICP around the optic nerve.Post-ONSF, the patient experienced significant improvement in papilloedema and visual symptoms.Follow-up confirmed reduced optic nerve swelling, with subjective improvement in vision.This case underscores ONSF as a successful treatment for refractory IIH-associated papilloedema, particularly when medical management alone is insufficient.Early recognition and interdisciplinary management are crucial for optimising outcomes in IIH-associated papilloedema.