Background: Papilledema is a common clinical problem where the ophthalmologist plays an important role in its diagnosis^. Optical coherence tomography (OCT) provides high resolution images of the retina and the retinal nerve fiber layer (RNFL). Objective: The aim of the work wasearly and non- invasive diagnosis of papilledema and differentiating it from pseudopapilledema using optical coherence tomography (OCT). Patients and methods: This observational case control study included a total of 45 eyes stratified into 3 equally groups, 15 each, (Group-1): eyes of healthy normal subjects, (Group-2) eyes with papilledema and (Group-3) eyes with pseudo-papilledema. Patients presented at Ophthalmology Outpatient Clinic, Zagazig University Hospitals. Follow-up visits included an interview with the patient for assessing the presence of ocular symptoms, and for ophthalmologic examination to register all the clinical findings. Results: There is statistically significant difference between the studied groups regarding result of fundus examination. Normal control group had normal appearance of fundus. Concerning pseudo papilledema, 73.3% had crowded disc and 26.7% had dusen. Concerning papilledema, 40% had mild lesion, 20% had moderate and remaining 40% had severe lesion. There is statistically significant difference between the studied groups regarding morphological changes. Crowded disc and buried optic disc drusen occurred in 73.3% and 26.7% of pseudopapilledema group respectively). There is statistically significant difference between the studied groups regarding superior RNFL. On LSD comparison, the difference is significant between each individual groups. There is statistically significant difference between the studied groups regarding inferior RNFL. Conclusion: It could be concluded that spectral domain optical coherence tomography can differentiate between papilledema, pseudopapilledema, and a normal disc.