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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 12
Patient Presentation: A 27-year-old male with a past medical history of multiple myeloma presented with 5 days vision loss OD. His visual acuity was CF @ 1ft OD and 20/20 OS. There is a right RAPD. Humphrey visual fields are shown below
Question: A dilated fundus examination is performed with OCT 5-line raster images with vertically-oriented lines as shown above. What is the main abnormality seen on the OCT?
Fundus auto-fluorescence provided additional confirmation of retinal folds. Linear striations with increased signal intensity are visualized as shown above (red arrows).
Question: What are potential causes of retinal folds?
Question: Given the examination and OCT findings, where is the compressive lesion causing the optic neuropathy?
Question: What is the most common ocular complications associated with multiple myeloma?
References:
1. Franklin RM, Kenyon KR, Green WR, Saral R, Humphrey R. Epibulbar IgA Plasmacytoma Occurring in Multiple Myeloma. Arch Ophthalmol. 1982;100(3):451–456.
2. Fung S, Selva D, Leibovitch I, Hsuan J, Crompton J. Ophthalmic Manifestations of Multiple Myeloma. Ophthalmologica. 2005. 219;43-8.
Learning Objectives:
1. To recognize and diagnose retinal folds on OCT
2. To recognize the ocular manifestations associated with multiple myeloma
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