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Type C Carotid Cavernous Fistula A patient presented with acute, painless, intermittent double vision. The patient had a past medical history of hypertension, hyperlipidemia, and myocardial infarction. The presenting visual acuity was 20/25 in both eyes with normal pupillary responses and intraocul…

Thyroid Associated Ophthalmopathy with Compressive Optic Neuropathy A patient presented for a second opinion after experiencing pain, proptosis, vision loss, and injection of his left eye for 2 years, with intermittent improvement on systemic steroids. Prior to presentation at our institution, the …

This patient presented with optic nerve edema. The medical history was significant for acute promyelocytic leukemia being treated with all-trans retinoic acid (ATRA). The picture however worsened in tandem with intracranial hemorrhage from possible intracranial leukemia, raising the concern for leu…

Vitamin A Induced Intracranial Hypertension A patient was found to have acute promyelocytic leukemia and was started on all-trans-retinoic acid (ATRA). He was also noted to incidentally have bilateral papilledema and MR imaging demonstrated multiple stigmata suggestive of chronically elevated intra…

Idiopathic Intracranial Hypertension with Secondary Choroidal Neovascular Membrane A patient with no past ocular history presented to the emergency department complaining of floaters in the left eye for 4 days. Exam was notable for visual acuity of 20/20 in the right eye and 20/25 in the left eye. …

Fundus photo demonstrating grade 1 optic nerve head edema in the right eye and grade 3 optic nerve head edema in the left eye. The left eye also demonstrates retinal folds, subretinal hemorrhage, and leakage on fluorescein angiography consistent with a choroidal neovascular membrane.

Optic Nerve Pit Optic nerve anomalies are rare entities with a variety of clinical presentations. They can be classified according to anomalies of disc size, disc conformation, or by the presence of abnormal tissue on the optic nerve head, or pseudoswelling. Here, we present a child with an inciden…

Traumatic Optic Neuropathy A patient presented with no light perception four days following being hit in the eye with a curling iron. Besides decreased vision, an afferent pupillary defect, and periorbital edema/ecchymosis, clinical exam including of the optic nerve was otherwise unremarkable. Init…

POEMS Syndrome A patient presented for evaluation of grade 4 optic disc swelling in both eyes. The patient has a history of polyneuropathy both sensory and motor involving the upper limbs more than lower limbs consistent with a diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) a…

Radiation Optic Neuropathy A patient with a history of skull base meningioma status-post gamma knife radiation presented with three weeks of decreased vision in both eyes. She had no light perception in the right eye and a visual acuity of 20/50 in the left. Magnetic resonance imaging of the brain …

Miller Fisher Syndrome A patient presented with binocular diplopia of 2 weeks duration after COVID-19 infection. Additionally, she had neurological symptoms, weakness, tingling, numbness of extremities. She had been fully vaccinated against COVID-19. On exam her BCVA was 20/20 OU, she was noted to …

Wernicke Encephalopathy A patient with past history of bariatric surgery presenting with blurred vision, oscillopsia and decreased hearing of few days. Her exam was remarkable for up-beating nystagmus in all gazes. Vision was 20/20 in each eye, pupils equal and reaction. She had full ocular motilit…

Leber Hereditary Optic Neuropathy (LHON) A previously healthy patient presented to the emergency department (ED) with a 2-week history of bilateral blurry vision associated with painful eye movement. The patient denied eye redness, eye discharge, photophobia, double vision, or headache. The ophthal…

Nyctalopia Due to Vitamin A Deficiency A patient with a past medical history of liver cirrhosis, presented to the neuro-ophthalmology clinic with blurry vision in both eyes and nyctalopia that started around a year ago. Ophthalmological exam was notable for a visual acuity of 20/40 in both eyes, re…

A pediatric patient with leukemic infiltrate of the optic nerve in both eyes.

Leukemic Optic Neuropathy Leukemic optic neuropathy is a rare entity that is characterized as optic nerve dysfunction resulting from direct infiltration of neoplastic leukocytes. It is an indicator of central nervous system involvement, and it is a neuro-ophthalmic and oncologic emergency that warr…

Extra-Parenchymal Neurocysticercosis (NCC) A patient presented with blurry vision and headaches for 6 months. He was found to have grade 5 papilledema with hemorrhages. MRI brain/orbits showed bilateral flattening of the posterior sclera with intraocular protrusion of the optic nerve head and promi…

Bartonella Henselae Neuroretinitis and Branch Retinal Artery Occlusion A patient with past ocular history of viral conjunctivitis presented with 2 weeks of decreased vision in the right eye. His exam was notable for visual acuity of 20/80+1 in the right eye and 20/20 in the left eye. Intraocular pr…

Non-Arteritic Anterior Ischemic Optic Neuropathy 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…