A 50-Year-Old Man With Optic Disc Edema

Rod Foroozan, MD


June 25, 2019

Case Presentation

A 50-year-old man noted blurred vision in his left eye. He had a history of exotropia since childhood.

He has a history of hypertension, for which he takes lisinopril and nebivolol, and obesity (body mass index, 37.95 kg/m2). He drinks alcohol occasionally and does not use tobacco. There is no family history of visual loss.

Visual acuity was 20/20 in the right eye and 20/60 in the left eye. Color vision with pseudoisochromatic plates was 10/10 in both eyes. Pupils were briskly reactive with a small relative afferent pupillary defect in the left eye. Automated perimetry showed visual field defects in each eye (Figure 1). He had a comitant 40 prism diopter exotropia with mild adduction deficits of each eye.

Intraocular pressure was 17 mm Hg in the right eye and 16 mm Hg in the left eye.

Slit lamp examination of the anterior segment was normal in each eye. There were cells in the vitreous of each eye, and funduscopic examination showed optic disc edema in each eye with retinal hemorrhage in the left eye (Figure 2). There were chorioretinal scars adjacent to the optic disc in each eye.

Results from an MRI of the brain with contrast and magnetic resonance venography of the head were both normal.

Lumbar puncture showed an opening pressure of 28 cm H2O. The cerebrospinal fluid protein level was 80 mg/dL (normal range, 12-45 mg/dL), with 12 white blood cells/µL (normal count, < 10 white blood cells/µL).

Figure 1. Automated perimetry showing enlargement of the blind spot with a nasal defect in the left eye and enlargement of the blind spot in the right eye.

Figure 2. Funduscopic examination showing optic disc edema in each eye. There is chorioretinal scarring in each eye and a parapapillary hemorrhage in the left eye.


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