BRIEF RESEARCH REPORT article
Front. Ophthalmol.
Sec. Neuro-Ophthalmology Disorders
Visual outcomes in a series of patients with papilledema and comorbid nutritional deficiency
Provisionally accepted
- 1School of Medicine, Washington University in St. Louis, St. Louis, United States
- 2Department of Ophthalmology and Visual Science and Department of Neurology, Yale School of Medicine, New Haven, United States
- 3John F. Hardesty, MD Department of Ophthalmology and Visual Sciences and Department of Neurology, Washington University in St Louis, St. Louis, United States
- 4John F. Hardesty, MD Department of Ophthalmology and Visual Sciences and Department of Neurology, Washington University in St. Louis, St. Louis, United States
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Abstract Background: Fulminant papilledema is a neuro-ophthalmologic emergency that can lead to permanent vision loss as a result of optic neuropathy. Despite appropriate treatment of intracranial hypertension and improvement of papilledema, some patients continue to experience worsening vision. In some cases, comorbid micronutrient deficiencies, which are an additional cause of optic neuropathy, may contribute to this decline. This case series highlights patients with papilledema whose vision worsened despite improving papilledema and were found to have comorbid nutritional deficiencies. Methods: A retrospective case series of three patients with papilledema seen between 2019 and 2022 at Washington University in St. Louis and Barnes Jewish Hospital. All experienced continued vision loss despite successful treatment of intracranial hypertension and were subsequently also diagnosed with nutritional deficiencies. Data on BMI, visual acuity, papilledema grade, optical coherence tomography findings, visual fields, and treatment outcomes were analyzed. Results: These three female patients had worsening vision despite medical and/or surgical treatment for intracranial hypertension. All were found to have comorbid nutritional deficiencies (thiamine, B12, folate, and/or copper). Following appropriate nutritional supplementation, none experienced continued worsening of their visual function. Conclusions: Worsened vision loss despite papilledema resolution may occur in patients with comorbid nutritional deficiencies. Though we cannot prove a causative relationship with our case series, it may be worth considering screening for micronutrient deficiencies in at-risk patients, as these deficiencies can have visual consequences and are straightforward to treat.
Keywords: Papilledema, Iih, micronutrient deficiencies, Nutritional optic neuropathy, satisfaction of search error
Received: 14 Sep 2025; Accepted: 28 Nov 2025.
Copyright: © 2025 Spiegelman, Burkland, Jameyfield, Van Stavern and Stunkel. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Leanne Stunkel
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