Table 3.

Papilledema Grading Scale (Frisén Scale)³⁹

Papilledema Grading Scale (Frisén Scale)39
Stage 0 - Normal Optic Disc. Blurring of nasal and temporal poles in inverse proportion to disc diameter. Radial pattern of peripapillary nerve fiber bundles without tortuosity. Rare obscuration of a major blood vessel at the disc border, usually in the upper pole.
Stage 1 - Very Early Papilledema. Excessive blurring of the nasal border of the disc with disruption of the normal radial arrangement of nerve fiber bundles. Normal temporal disc margin. Formation of subtle grayish halo along circumference of optic disc (best seen with indirect ophthalmoscopy) with temporal gap.
Stage 2 - Early Papilledema. More pronounced elevation of the nasal border of the disc with blurring of the entire temporal margin. Peripapillary halo completely surrounding the disc. Concentric or radial retrochoroidal folds may be present.
Stage 3 - Moderate Papilledema. Elevation of the temporal border of the disc with clearly increased diameter of optic nerve head. Obscuration of one or more segments of major retinal vessels. Peripapillary halo featuring irregular outer fringe with finger-like extensions.
Stage 4 - Marked Papilledema. Elevation of the entire nerve head with obliteration of the optic cup or compression of the cup to a slit or total obscuration of a segment of the central retinal artery or vein.
Stage 5 - Severe Papilledema. Smooth, dome-shaped protrusion of the optic nerve head representing anterior expansion out of proportion to sideways expansion. Peripapillary halo is narrow and smoothly demarcated. Major retinal vessels climb steeply over dome surface, with or without total obscuration by swollen tissue.