From Early Descriptions to Modern Imaging: The Evolving Understanding of Papilledema

Papilledema has long been recognised as a cardinal sign of elevated intracranial pressure, yet its structural underpinnings and dynamic behaviour have only recently become accessible through modern ocular imaging. This review traces the historical development of papilledema understanding, from early anatomical descriptions and the introduction of the ophthalmoscope to contemporary high-resolution imaging, and synthesises current evidence on the structural deformation of the optic nerve head in intracranial hypertension. Particular emphasis is placed on anterior displacement of the optic disc, a parameter that complements peripapillary retinal nerve fibre layer thickness assessment and offers unique insight into pressure-related biomechanics. We summarise key studies evaluating optic disc morphology across different aetiologies, treatment modalities, and time courses, highlighting the emergence of deformation of the optic nerve head patterns and their potential diagnostic and prognostic relevance. By integrating historical context, methodological advances, and contemporary evidence, this review outlines how structural imaging has reshaped current understanding and may further refine clinical assessment of papilledema.