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Optic nerve head swelling can be a significant challenge in clinical practice when clinicians are required to differentiate true swelling (papilledema) from pseudo-papilledema (benign elevation of the optic nerve head). This case presentation describes a patient who experienced an ocular laceration that led to a vitreal prolapse and ocular hypotony. The ocular hypotony led to papilledema and retinal edema extending throughout the macular region of the right eye. The patient has been followed over a 2 year period with gradual improvement in visual acuity, visual field and various aspects of optical coherence tomography (OCT) measurements. The long-term follow up provides useful insights on the time-course of potential recovery, including the time course of reduction in retinal and optic nerve edema and identifies many useful and some pitfalls to be avoided when interpreting OCT imaging. Finally, an overview will be provided on discriminating true from pseudo-optic nerve head swelling using selected cases from the Centre for Eye Health.