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Updated: Feb 8, 2026

Optic Nerve Sheath Point of Care Ultrasound: Image Acquisition
Published on: August 18, 2023
The Translaminar Pressure Gradient: Papilledema After Trabeculectomy Treated With Optic Nerve Sheath Fenestration
Phillip M Radke1,2, Tal J Rubinstein1,2, Steven R Hamilton3
1Allure Laser Center & Medispa, Kirkland.
Introduction:
Trans-lamina cribrosa pressure has been postulated to be a contributor in the development of a glaucomatous optic nerve versus optic nerve edema, depending on the pressure gradient. Uncertainty remains in the therapeutic outcome of adjusting this gradient.
Case Report:
We discuss a unique case of idiopathic intracranial hypertension presenting as asymmetric optic disc edema following trabeculectomy. It was treated via optic nerve fenestration due to the patient remaining symptomatic on maximum tolerated acetazolamide. Intraocular pressure stabilized into target range and the optic nerve edema resolved.
Conclusions:
Rarely, intraocular pressure reduction can unmask elevated intracranial pressure, leading to optic nerve edema. Optic nerve sheath fenestration is a practical therapeutic modality to consider when treating this occurrence.
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