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Presentation type	E-poster
Title	Two Eyes, Twice the Insight: The Lesson of Contralateral Papilledema

Purpose	Although the ophthalmologic examination is often perceived as a routine procedure, it is critically important in the workup of a central lesion. The degree of papilledema - or when this cannot be reliably assessed, the extent of ganglion cell loss - both caused by a supratentorial mass lesion - is pivotal in determining both the necessity and urgency for neurosurgical intervention. An incomplete or unfocused examination can therefore have major clinical consequences.
Methods	We report the case of a patient with a left-sided, conservatively managed sphenoid meningioma, presenting with chronic, progressive vision loss in the contralateral right eye. Ophthalmologic evaluation revealed optic neuropathy confined to the contralateral side. Further radiological imaging uncovered an unusually long, tortuous ipsilateral optic nerve, which likely protected it from developing papilledema. In contrast, the anatomically normal-length contralateral optic nerve had developed papilledema, as expected from the mass effect of the sphenoid meningoma, with the optic disc already showing signs of atrophy
Results	The absence of ipsilateral papilledema due to the elongated anatomy of the ipsilateral optic nerve not only complicates the ophthalmologic diagnosis, but may also risks underestimating the severity and chronicity of the intracranial lesion, potentially delaying proper intervention.
Conclusion	This case therefore vividly underscores the critical importance of a comprehensive binocular ophthalmologic examination in central lesions, even when unilateral.
Conflict of interest	No
Details of conflicting interests	/

Authors 1

Last name	DECRAENE
Initials	B
Department	Ophthalmology
City	Leuven

Authors 2

Last name	Sarono
Initials	J
Department	Ophthalmology
City	Leuven

Authors 3

Last name	Lambert
Initials	J
Department	Radiology
City	Leuven

Authors 4

Last name	Decramer
Initials	T
Department	Neurosurgery
City	Leuven

Authors 5

Last name	Cassiman
Initials	C
Department	Ophthalmology
City	Leuven