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Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.

On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.

A dilated fundus examination was performed demonstrating the following:

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Neuro-Ophthalmology

Case 10

Patient Presentation: A 64-year-old female was referred to neuro-ophthalmology clinic for bilateral blurred optic disc margins. Her past medical history was significant for obesity. Visual acuity was 20/40 OD and 20/30 OS with equal pupil sizes and no RAPD. Colour vision was 14/14 on Ishihara plates OU. Fundus photos and Humphrey 24-2 SITA-fast visual fields are shown below:

Neuro-Ophthalmology 10-1.png

There are indistinct nasal optic disc margins in both eyes.

Neuro-Ophthalmology 10-2.png

Visual fields show non-specific depressed points in both eyes.

An OCT RNFL was performed below:

Neuro-Ophthalmology 10-3.png

Question: What pathology is seen on the OCT RNFL?

A. Thin RNFL thickness OU

B. Cupping of the optic nerve

C. Abnormal B-scan images

D. Symmetric RNFL

Neuro-Ophthalmology 10-6.png

Neuro-Ophthalmology 10-7.png

Question: A spectralis OCT of the optic nerve heads were conducted and shown above. What disease process is seen on the above OCT images?

A. Vitreopapillary traction

B. Retinal detachment

C. Optic nerve head excavation

D. Disorganization of retinal layers

References:

1. Hedges TR, Flattem NL, Bagga A. Vitreopapillary traction confirmed by optical coherence tomography. JAMA Ophthalmol 2006;124(2):279-281.

Learning Objectives:

1. To recognize signs of vitreopapillary traction on OCT and to include in the differential of asymptomatic optic disc edema.

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