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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 26
Patient Presentation: A 41-year-old woman with a known history of idiopathic intracranial hypertension (IIH) presented with a 2 day history of painless decreased vision OS. The patient noted she had a head and neck massage in prone position 2 hours prior to her visual disturbance. She was using 500mg PO Diamox daily. On examination, visual acuity was 20/20 OD and 20/40 OS. There was no RAPD. Fundus photographs were taken and are shown below:
An OCT ONH/RNFL was taken and is shown below:
Question 1: What is the main finding in the OCT ONH/RNFL above?
An OCT 5-line raster over the left optic nerve was taken and is shown below:
Question 2: What is the main finding in the left eye OCT 5-line raster above?
References:
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Di Ianni J, Pereira A, Micieli JA. Vitreous Hemorrhage from Papilledema After Neck Massage. Ophthalmology. 2023;doi:10.1016/j.ophtha.2022.12.015
Learning Objectives:
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To recognize an optic disc hemorrhage on OCT imaging.
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