The use of oral fluorescein in the diagnosis of early papilledema in 23 children aged 1 mo to 10 yrs is reported from the Dr Rajendra Prasad Centre for Ophthalmic Sciences, All-India Inst of Med Sciences, Ansari Nagar, New Delhi, India. Of 15 children with suspected or early papilledema associated with hydrocephalus (10), seizures (3), possible tumor (1), and unilateral proptosis (1), late disc staining and retinal vascular fluorescence occurred in 12, the fluorescence at 60 min being significantly greater or of equal intensity to that at 30 min, denoting a positive test. All cases positive on oral fluorescein showed CT evidence of raised intracranial pressure, while those with negative fluorescein tests had normal CT’s. In 8 children with pseudopapilledema examined after oral fluorescein, the retinal vascular fluor-escence and slight disc head staining with sharp margins at 30 min declined markedly by 60 min, a negative result, identical to that found in normal fundi. The authors caution that a negative result may occur with very early stages of papilledema manifested only by venous engorgement. [1]

COMMENT. The necessity for conventional intravenous administration of fluorescein often precludes its use in small children with suspected papilledema. Oral fluorescein offers a more practical test that may gain acceptance if these results are confirmed. The funduscopic examination and diagnosis of early papilledema is often difficult, especially in small children, even for the experienced pediatric neurologist. Ophthalmologists may negate the neurologist’s suspicions, but CT scan is nonetheless advisable if the clinical picture suggests a space-occupying lesion.