An Elderly Patient's Blurry Right Eye Raises Questions

Karima S. Khimani; Rod Foroozan, MD

Disclosures

July 24, 2017

Case Diagnosis

Isolated chronic elevation of the optic disc with relatively preserved visual function raises suspicion for vitreopapillary traction (VPT). This diagnosis can be confirmed by OCT, as it was in this patient.

Idiopathic intracranial hypertension typically presents with bilateral optic disc edema secondary to elevated intracranial pressure (papilledema). Patients usually experience headaches, diplopia, episodes of transient visual loss, and progressive loss of peripheral vision. Some patients also report pulsatile tinnitus and radicular pain in shoulders and neck. This condition predominantly affects obese women of childbearing age.

Optic neuritis is commonly associated with multiple sclerosis and involves demyelinating inflammation of the optic nerve. It is characterized by an acute onset of unilateral vision loss, usually associated with ocular pain that is worsened by eye movement, followed by gradual recovery of visual function. Patients also present with decreased color vision in the affected eye. Typically, a relative afferent pupillary defect is noted in the affected eye. This patient had none of these features.

Central retinal vein occlusion is more commonly seen in patients with diabetes and high blood pressure. Funduscopic examination shows retinal hemorrhages, dilated tortuous veins, cotton-wool spots, macular edema, and occasionally optic disc edema. This patient had a normal peripheral retina and macula in each eye.

Clinical Course

The patient returned 10 months later with persistently blurry vision in the right eye. She noted occasional photopsia, and OCT of the RNFL showed persistent elevation of the optic disc in the right eye. Visual acuity was stable from the previous visit. OCT of the RNFL showed persistent vitreopapillary traction in the right eye that was stable. The patient was instructed to follow up for a repeat funduscopic examination and OCT to monitor the VPT.

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