Radiation Optic Neuropathy
A patient with a history of proton beam therapy for a chordoma near the clivus presented with 1 week of blurry vision in the left eye. On presentation, patient’s exam was notable for a visual acuity of 20/25 in the right eye and 20/50 in the left eye. Intraocular pressure was 15 and 12 in the right and left eyes, respectively. Slit lamp revealed an elevated C/D ratio of 0.6 on the right and 0.3 on the left. An APD was noted on the left side. HVF 30-2 revealed a nasal and superior arcuate defect in the right eye and a dense superior hemifield defect encroaching on central vision in the left. Labs, including ESR/CRP, were normal. Within 3 months, patient’s vision decreased to HM in the right eye and E at Face in the left eye with corresponding optic nerve pallor in both eyes. An MRI was performed which was consistent with post-radiation changes and did not reveal a compressive lesion. Given her clinical and imaging findings, radiation optic neuropathy was diagnosed.
Presentation Date: 03/21/2024
Issue Date: 04/05/2024
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