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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 19
Contributor: Arshia Eshtiaghi (CC3)
Patient Presentation: A 24-year-old woman was referred to a tertiary ophthalmology clinic after reporting 3 days of painless, blurred vision in the superior field of her left eye. Her past medical history was significant for congenital nephrotic syndrome; she was receiving hemodialysis every other day for the last 2 years. On examination, her best-corrected distance visual acuity is 20/20 OU. There was a left RAPD. Fundus examination was performed and shown below:
Further review of the patient’s electronic medical record demonstrated 7 episodes of hypotension during dialysis treatments over the last 3 months, the most recent event being one week ago where her blood pressure fell to 70/40 for 5 minutes.
Question: What is the most likely diagnosis for this patient?
OCTs of the retinal nerve fiber layer and ganglion cell analysis were acquired and shown below.
Question: How would you describe these OCTs in the left eye?
A second series of OCTs of the retinal nerve fiber layer and ganglion cell analysis were acquired and shown below.
Question: Based on the above OCTs, when were these OCTs performed in relation to the patient’s clinical presentation?
Question: What can we expect on repeat RNFL and GCA analysis in a year from now?
Question: What treatment recommendation should be made to prevent subsequent NAION in the fellow eye?
References:
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Cestari DM, Gaier ED, Bouzika P, et al. Demographic, Systemic, and Ocular Factors Associated with Nonarteritic Anterior Ischemic Optic Neuropathy. Ophthalmology. 2016. doi:10.1016/j.ophtha.2016.08.017
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Kerr NM, Chew SSSL, Danesh-Meyer H V. Non-arteritic anterior ischaemic optic neuropathy: A review and update. J Clin Neurosci. 2009. doi:10.1016/j.jocn.2009.04.002
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Fard MA, Ghahvehchian H, Subramanian PS. Optical coherence tomography in ischemic optic neuropathy. Ann Eye Sci. 2020. doi:10.21037/aes.2019.12.05
Learning Objectives:
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To identify the classic clinical, fundus and OCT signs of NAION.
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