Purpose: Evaluation of the peripapillary microvascular density and neuronal changes in patients with idiopathic intracranial hypertension (IIH) in correlation with the degree of papilledema clinically at time of presentation. Methods: This case-control study included 112 eyes of 84 individuals. They were divided into IIH with papilledema group; 56 eyes of 28 patients and control group; 56 eyes of 56 healthy age and sex matched participants. Optical coherence tomography angiography (OCTA) to evaluate the Retinal nerve fiber layer (RNFL) and peripapillary capillary vessel density (CVD) was done with colored fundus photography for documentation of papilledema. Results: The difference in CVD and RNFL were statistically significant between both groups with lower vessel density and thicker RNFL in the IIH group. The thickness of the RNFL was correlated with the degree of papilledema unlike CVD. Conclusion: OCT-A revealed a reduction in the CVD, which could be caused by the thickening the RNFL due to swelling of the axons in the per-ipapillary area caused by papilledema. Overall, OCT-A has the ability to quantify CVD, identify areas of hypoperfusion, and spot early ischemic abnormalities in IIH patients before they develop optic nerve atrophy.