BACKGROUND: Pediatric papilledema is a common reason for ophthalmology evaluation in high acuity emergency department and inpatient settings. This study describes the frequency of consultation, causative diagnoses, and presenting characteristics of papilledema at a tertiary care children's hospital. METHODS: All consecutive patients seen in pediatric ophthalmology consultation or diagnosed with papilledema at a large children's hospital between January 1, 2021, and August 18, 2023, were retrospectively reviewed. Patients with papilledema (disk edema from elevated intracranial pressure) were identified and included in the analysis. Clinical characteristics of their presentations and the diagnoses underlying their elevated intracranial pressures were obtained. Age stratification into three groups for additional analysis was performed. RESULTS: A total of 71 patients were identified with papilledema. Mean patient age was 13 ± 5.2 years (range, 0-20 years), and 68% of patients were girls. The overall rate of papilledema diagnosis among all unique patient consultations was 3.7%. Papilledema was caused by idiopathic intracranial hypertension (IIH) in 36 cases (51%), and 35 cases (49%) were due to secondary causes of IHH with serious vision- and life-threatening implications. IIH was most common in children >
12 years of age, comprising 60% of papilledema cases in the age group. CONCLUSIONS: Pediatric papilledema is associated with a wide range of extremely serious underlying conditions that require a comprehensive, multidisciplinary evaluation in an emergency setting.