To assess changes in central retinal artery (CRA) blood flow by orbital color-coded Doppler ultrasonography in patients with idiopathic intracranial hypertension (IIH) and their relation with optic nerve (ON) elasticity assessed by shear wave elastography (SWE).

This study was carried out on 68 eyes of patients diagnosed with IIH and 32 eyes of healthy controls. The severity of papilledema in IIH patients was sub-classified into mild and moderate/severe groups. Color-coded Doppler was used to measure peak systolic velocity (PSV), end diastolic velocity (EDV), mean velocity (V_mean) and pulsatility index (PI) of the CRA.

PSV, V_mean, and SWE were significantly higher in patients with IIH than in controls (p = 0.001). The optimal cut-off values of PSV and V_mean for differentiating IIH patients from controls were 11.25 and 6.75 cm/s with AUC 0.81 and 0.785 respectively. AUC was 0.92 and accuracy 91% for combined PSV, V_mean and SWE differentiation between IIH patients and controls. PSV, V_mean and SWE were significantly different between mild versus moderate/severe papilledema (p = 0.001). PSV and V_mean were correlated with papilledema (r = 0.790 and 0.722 respectively) and SWE (r = 0.818 and 0.761 respectively).

IIH is associated with decreased ON elasticity and reduced CRA blood flow. Individual and combined color-coded Doppler of the CRA and SWE help in diagnosis of IIH. CRA hemodynamic changes are correlated with papilledema severity and with the extent of biomechanical changes in the ON represented by SWE.