Ophthalmologic assessment and intracranial pressure in children: diagnostic methods, clinical correlations, and future directions

Increased intracranial pressure (ICP) in the pediatric population represents a critical and potentially life-threatening condition that may lead to severe neurological sequelae, including brain herniation, cerebral ischemia, and irreversible neurological impairment, such as visual loss. The diagnosis of elevated ICP in children is particularly complex, as clinical manifestations are frequently subtle and non-specific, especially in infants and young children. Symptoms such as irritability, poor feeding, lethargy, and failure to thrive often overlap with a wide range of common pediatric disorders, thereby contributing to delayed diagnosis and an increased risk of adverse neurological outcomes. Within this context, ophthalmologic evaluation constitutes a key non-invasive tool in the early detection of increased ICP. Fundoscopic examination provides critical diagnostic information, with optic disc abnormalities among the most sensitive markers of elevated ICP. However, these findings may be less pronounced or exhibit distinct characteristics in children compared to adults, and their interpretation is further complicated by age-related variability in ocular anatomy and intracranial pressure norms. This review provides an integrated synthesis of current diagnostic strategies for assessing elevated ICP in children, with a particular focus on ophthalmologic assessment. It examines the association between specific ocular findings and ICP, with the aim of improving early recognition, guiding clinical management, and enhancing patient outcomes. Furthermore, it addresses the inherent challenges of pediatric ICP diagnosis and highlights key gaps in the literature that warrant further investigation.