What feature distinguishes papilledema from optic neuritis on fundoscopic examination?

• A. Papilledema is bilateral with disc edema and venous engorgement from raised intracranial pressure; optic neuritis is typically unilateral with disc edema, pain with eye movement, and potential vision loss
• B. Papilledema is unilateral with disc edema and venous engorgement
• C. Optic neuritis is bilateral with pain on eye movement
• D. Papilledema shows pallor of the optic disc

Answer: (A)

The key idea is that the pattern of optic disc swelling differs between the two conditions. Papilledema, caused by raised intracranial pressure, typically presents with swelling of the optic discs in both eyes (bilateral, symmetric) along with engorged retinal veins. Optic neuritis, on the other hand, usually affects one eye and presents with unilateral disc edema accompanied by pain with eye movements and possible vision loss. So the defining take-home on fundoscopic exam is bilateral disc edema with venous engorgement for papilledema versus unilateral swelling with pain on movement for optic neuritis.