Identification of papilloedema in general practice in England: a mixed-methods cross-sectional study
- 1Centre for Academic Primary Care, Bristol University, Bristol, UK
- 2Bristol Medical School, Bristol, UK
- 3Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
Abstract
Background: Papilloedema, defined as optic nerve swelling caused by raised intracranial pressure, may present with headache and can indicate serious underlying intracranial disease. General practitioners (GPs) encounter papilloedema infrequently yet missed diagnoses may result in delayed identification of potentially life-threatening conditions. Recognising papilloedema in primary care is often challenging.
Objective: To explore GPs’ perspectives on identifying and referring patients with papilloedema.
Design, setting and participants: A mixed-methods cross-sectional study of GPs in England.
Intervention/methods: Six National Institute for Health and Care Research Clinical Research Networks disseminated a questionnaire to GPs (June to October 2023); responses were analysed using quantitative/qualitative methods. Five GPs who completed the questionnaire were interviewed by video call. Interviews were thematically analysed.
Results: 45 GPs completed the questionnaire. In a case vignette presenting with headache, most GPs (78%) would perform fundoscopy, but were not confident in identifying papilloedema. Nearly half (49%) recommended the case to see a community optometrist who was considered better skilled and equipped to examine eyes. GPs said current practices could be improved by allowing optometrists to refer patients directly to appropriate hospital specialists.
Four themes were identified from five interviews: the GP’s role in suspecting papilloedema; challenges in assessing patients for papilloedema; the impact when local protocols and pathways for suspected papilloedema are not available; and the need for clarity and support in dealing with suspected papilloedema.
Conclusion: Although GPs rarely encounter papilloedema, delayed or missed diagnosis may result in serious morbidity. The development of clear clinical pathways for assessing patients presenting with headache and optic disc swelling in primary care could support earlier recognition and appropriate referral.
Related
- Characterising patients in England with Down syndrome and Alzheimer's disease: a descriptive observational study using data from Clinical Practice Research Datalink linked to Hospital Episode Statistics.
- Ankle arthrodesis and total ankle replacement – Variations in surgical practice across England using Hospital Episode Statistics database
- Patient experiences of acute medical same day emergency care: a mixed-methods cross-sectional survey across two hospitals in England
- Prevalence of DSM-5 eating disorders and associated impairment and service use among children and young people in England: analysis of a general population survey
- Inequalities and practice-level predictors of cancer diagnostic activity: longitudinal study in England
BibTeX
@article{skrobot2026identification,
title = {{Identification of papilloedema in general practice in England: a mixed-methods cross-sectional study}},
author = {Olivia A Skrobot and Jonathan AK Chin and Matthew J Ridd and Samuel W D Merriel and Denize Atan and Alyson L Huntley},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-121321},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-121321},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Identification of papilloedema in general practice in England: a mixed-methods cross-sectional study
AU - Olivia A Skrobot
AU - Jonathan AK Chin
AU - Matthew J Ridd
AU - Samuel W D Merriel
AU - Denize Atan
AU - Alyson L Huntley
PY - 2026
DA - 2026/10/29
JO - BMJ Open
DO - 10.1136/bmjopen-2026-121321
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-121321
AB - Background: Papilloedema, defined as optic nerve swelling caused by raised intracranial pressure, may present with headache and can indicate serious underlying intracranial disease. General practitioners (GPs) encounter papilloedema infrequently yet missed diagnoses may result in delayed identification of potentially life-threatening conditions. Recognising papilloedema in primary care is often challenging. Objective: To explore GPs’ perspectives on identifying and referring patients with papilloedema. Design, setting and participants: A mixed-methods cross-sectional study of GPs in England. Intervention/methods: Six National Institute for Health and Care Research Clinical Research Networks disseminated a questionnaire to GPs (June to October 2023); responses were analysed using quantitative/qualitative methods. Five GPs who completed the questionnaire were interviewed by video call. Interviews were thematically analysed. Results: 45 GPs completed the questionnaire. In a case vignette presenting with headache, most GPs (78%) would perform fundoscopy, but were not confident in identifying papilloedema. Nearly half (49%) recommended the case to see a community optometrist who was considered better skilled and equipped to examine eyes. GPs said current practices could be improved by allowing optometrists to refer patients directly to appropriate hospital specialists. Four themes were identified from five interviews: the GP’s role in suspecting papilloedema; challenges in assessing patients for papilloedema; the impact when local protocols and pathways for suspected papilloedema are not available; and the need for clarity and support in dealing with suspected papilloedema. Conclusion: Although GPs rarely encounter papilloedema, delayed or missed diagnosis may result in serious morbidity. The development of clear clinical pathways for assessing patients presenting with headache and optic disc swelling in primary care could support earlier recognition and appropriate referral.
SN - 2044-6055
SN - 2044-6055
ER -