Table 1 Papilledema grading system (Frisen scale)

Grade 0: Normal optic disc blurring of nasal, superior and inferior poles in inverse proportion to disc diameter. Radial nerve fiber layer (NFL) without NFL tortuosity

Rare obscuration of a major blood vessel, usually on the upper pole

Grade 1-Very Early Papilledema: Obscuration of the nasal border of the disc. No elevation of the disc borders. Disruption of the normal radial NFL arrangement with

Grayish opacity accentuating nerve fiber layer bundles. Normal temporal disc margin. Subtle grayish halo with temporal gap (best seen with indirect ophthalmoscopy)

Concentric or radial retrochoroidal folds

Grade 2-Early Papilledema: Obscuration of all borders. Elevation of the nasal border. Complete peripapillary halo

Grade 3-Moderate Papilledema: Obscurations of all borders. Increased diameter of optic nerve head. Obscuration of one or more segments of major blood vessels

Leaving the disc. Peripapillary halo-irregular outer fringe with finger-like extensions

Grade 4-Marked Papilledema: Elevation of the entire nerve head. Obscuration of all borders. Peripapillary halo. Total obscuration on the disc of a segment of a major blood vessel

Grade 5-Severe Papilledema: Dome-shaped protrusions representing anterior expansion of the optic nerve head. Peripapillary halo is narrow and smoothly demarcated

Total obscuration of a segment of a major blood vessel may or may not be present. Obliteration of the optic cup