Introduction: Papilledema may lead to diagnostic difficulties in its different stages. It should be differenciates from optic neuropathies and structural abnormalities of the optic disk known as pseudopapilloedema. The new diagnostic techniques in ophthalmology may be useful to diagnose papilloedema as well as in further follow-up, even though they are not exempt of limitations.
Development: Optical coherence tomography is a non-invasive inferometric optical tomographic imaging technique that provides cross-sectional in vivo images of the optic nerve and the retina. Measurements of the retinal nerve fiber layer thickness and its subsequent analysis are very useful to detect subtle changes of loss or thickening. Eye ultrasonography is the most reliable method to reveal buried drusen of the optic disk head, a major cause of pseudopapilloedema. Fluorescein angiography reveals abnormalities in retinal vessel permeability in different types of optic disk swelling, which is helpful to decide whether it is a true papilloedema or a pseudopapilloedema.
Conclusions: Optical coherence tomography, ultrasonography and fluorescein angiography are low-invasive diagnostic techniques able to provide the clues to the correct diagnosis of true papilloedema at initial stages. They are also useful to rule out pseudopapilloedema and optic disk swelling secondary to other neuropathies.