Asymmetrical Intraocular Pressures and Asymmetrical Papilloedema in Pseudotumor Cerebri Syndrome

This report is of two cases of asymmetrical papilloedema in patients with asymmetrical intraocular pressures (IOPs). The first patient presented with headaches, transient visual obscurations (TVOs), and elevated IOPs, and was found to have increased intracranial pressure caused by a torcula meningioma. He developed papilloedema after his IOPs were pharmacologically lowered; the papilloedema resolved after the IOP became elevated again after stopping his glaucoma drops, and then again returned as the IOP reduced when the drops were restarted. The second patient with a history of Sturge-Weber syndrome requiring previous left trabeculectomy, presented with left-sided TVOs, photopsia, and pulsatile tinnitus caused by idiopathic intracranial hypertension. Asymmetrical papilloedema was observed, worse in the eye with the lower IOP following trabeculectomy. These cases suggest that asymmetric IOP may be one factor that can influence the development of asymmetric papilloedema. Ophthalmologists finding disc swelling at low normal pressures should ask about symptoms of raised ICP, and neuro-ophthalmologists confronted with asymmetrical disc swelling should routinely measure IOP.