Topic outline

  • Grand Rounds

    A patient presented to the Bascom Palmer Emergency Department with acute onset painless decreased vision in the right eye after awaking from sleep. The patient was found to have unilateral optic disc edema in the right eye. Visual acuity was 20/20 in both eyes. Intraocular pressure was within normal limits. Pupils were equally round and reactive to light. On exam, patient was found to have right optic disc edema. The patient reported a history of OSA but was not using a CPAP machine. MRI of the brain and orbits with and without contrast was performed which was within normal limits. Initial laboratory workup was unremarkable. Patient was followed in the Neuro-ophthalmology clinic with imaging including Humphrey Visual Field and OCT RNFL/GCL. The patient was started on aspirin and oral steroids. The patient later presented to the Bascom Palmer Emergency Department with another episode of right optic disc edema. The patient then underwent hematologic workup for possible thrombophilia/hypercoagulability, which revealed elevated lipoprotein a. The patient was evaluated by hematology and started on clopidogrel. The patient later presented to the Bascom Palmer Emergency Department with left optic disc edema and reported poor compliance with CPAP and clopidogrel.

    Presentation Date: 10/07/2021
    Issue Date: 11/05/2021