The Woman With Multiple Sclerosis and Blurry Vision

Rod Foroozan, MD; Iris Zhuang

Disclosures

July 30, 2018

Clinical Presentation

A 65-year-old woman with relapsing-remitting multiple sclerosis (RRMS) presents with blurred vision that is worse in the right eye. She denies diplopia and eye pain.

First diagnosed in 1999, complications from her RRMS include paraplegia, neurogenic bladder, and muscle spasticity. She does not have any other significant medical problems (eg, hypertension, diabetes mellitus). Her current medications include fingolimod for RRMS, which she has been taking since 2011; mirabegron for neurogenic bladder; vitamins B complex, C, D3, and E; and nutritional supplements.

Uncorrected visual acuity was 20/25 in both eyes. Visual fields were full to confrontation bilaterally and extraocular eye movements were intact. Pupils were equally round and reacted briskly to light with no relative afferent pupillary defect.

Intraocular pressure measured 9 mm Hg in the right eye and 11 mm Hg in the left eye.

Amsler grid testing, Ishihara testing, and the slit-lamp examination revealed no abnormalities. However, funduscopic examination revealed pale optic discs on each side with cystic spaces in the macula of the right eye.

Additionally, spectral domain optical coherence tomography (SD-OCT) through the macula of both eyes showed lucent inner retinal areas suggestive of cystic macular edema, worse in the right eye compared with the left eye (Figure 1). The thickness of the central macula was 423 μm in the right eye and 276 μm in the left eye.

Figure 1. SD-OCT through the macula revealing lucent inner retinal areas suggestive of cystic macular edema, worse in the right eye compared with the left eye.

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