Idiopathic Intracranial Hypertension and Ocular Changes

Background: Idiopathic Intracranial Hypertension (IIH), previously known as pseudotumor cerebri, is characterised by elevated intracranial pressure without an identifiable secondary cause and predominantly affects overweight women of reproductive age. Visual morbidity due to papilledema and secondary optic atrophy remains the most feared complication. Objective: To comprehensively review and synthesise current evidence on ocular structural, vascular, and functional changes associated with IIH, with emphasis on modern imaging biomarkers and their role in diagnosis and disease monitoring. Methods: A narrative review of published literature was performed, focusing on clinical ophthalmic findings, optical coherence tomography (OCT), OCT-angiography (OCT-A), and orbital neuroimaging features in IIH. Results: IIH primarily affects the optic nerve head and posterior segment, with minimal anterior segment involvement. Peripapillary retinal nerve fibre layer thickening, ganglion cell complex loss, retinal vascular remodelling, and characteristic MRI features such as optic nerve sheath distension and posterior globe flattening are consistently reported. OCT and OCT-A provide quantitative, reproducible biomarkers that correlate with intracranial pressure and visual function. Conclusion: Ocular imaging plays a pivotal role in the diagnosis, monitoring, and prognostication of IIH. Early detection and longitudinal OCT-based surveillance are essential for preventing irreversible vision loss.