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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 21
Patient Presentation: A 23-year-old female was referred to a neuro-ophthalmology clinic for possible optic disc edema. Her past medical history was significant for obesity. Visual acuity was 20/25 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:
There are indistinct nasal optic disc margins in both eyes.
Visual fields show non-specific depressed points in both eyes.
An OCT RNFL was performed below:
Question: What pathology is seen on the OCT RNFL?
A 5-line Raster OCT of the optic nerve heads were conducted and shown below:
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Question: What disease process is seen on the above OCT images?
Following conservative management, the patient returned for a 6-month follow-up. Her fundus photo of the right eye (shown below) demonstrated marked improvement of the blurred nasal disc margin. This change was also appreciated in the left eye.
The HD Cross OCT over the optic nerve OD at the 6-month follow-up is shown below:
Question: What is the key difference in this follow-up OCT macula image compared to initial presentation?
Learning Objectives:
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To recognize signs of vitreopapillary traction on OCT and to include in the differential of asymptomatic optic disc edema.
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