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Alstrom Syndrome A 5-year-old male referred to the BPEI pediatric ophthalmology clinic for second opinion regarding bilateral progressive vision loss since infancy. VA was 20/200 OU and the patient had nystagmus. He was 99% percentile for weight but had no hearing loss or polydactyl. He underwent s…

The patient presented with ocular ischemic syndrome and corneal edema in the fellow eye. In the right eye on angiography there is temporal non-perfusion as well as choroidal hyperfluorescent infarcts in the late phases. ESR and CRP were elevated. Diagnosis of GCA was made. The patient retained 20/3…

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…

Bartonella Neuroretinitis A patient presented with subacute painless decreased vision in the left eye. On examination, she had evidence of stellate macular exudates in the left eye, as well as optic disc edema in the right eye. Imaging including fluorescein angiography and OCT of the macula and ret…

Bilateral Ischemic Optic Neuropathy Following Buttock Augmentation in an IIH Suspect A 51-year-old female was transferred from an outside facility 5 days after buttock augmentation surgery in the prone position. On examination, there was no light perception in the right eye and hand motion vision i…

Bilateral Optic Neuritis A 36-year-old male presented to ER with sudden loss of vision in both eyes, associated with sever periorbital pain, photophobia and pain with eye movement. Vision was NLP right eye and 20/70 left eye with a right afferent pupillary defect in the right eye. Eye movements wer…

Bilateral Papillitis A 66-year-old man presented to Bascom Palmer with complaints of blurry vision in both eyes for three days which he described as painless. Vision was 20/350 in the right and 20/200 in the left eye with evident papillitis in both eyes on exam. An MRI revealed no retrobulbar optic…

Bosch-Boonstra-Schaaf Syndrome The following case review presents a 3-year-old, born full term, with developmental delay which was referred by an outside physician for further evaluation. Further testing was required for a final diagnosis which included an MRI of the brain and genetic testing. Resu…

Slit lamp photo with dilated epi-scleral veins. Fundus photo with retinal hemorrhages. FA with severe non perfusion, leakage from the disc, and laser scars. MRI/MRA demonstrates left distal precavernous/proximal cavernous ICA fistula into the cavernous sinus with arterialized flow. There is resulta…

Cranial Nerve 6 Palsy from Metastatic Cholangiocarcinoma A 34-year-old woman presented with 2 weeks of diplopia. The patient had binocular horizontal diplopia with a right cranial nerve 6 palsy and moderate-to-severe headache of 1-week duration. Magnetic resonance imaging (MRI) of the brain and orb…

Downbeat Nystagmus A patient was referred with double vision and oscillopsia. He reported to have nystagmus and oscillopsia for a few years, and recently mild worsening. He denies head trauma, weakness, numbness, changes in his vision, transient visual loss, or headache. Patient has trouble reading…

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…

Increased intracranial pressure leading to bilateral optic nerve edema. Grade 5 is considered when all vessels are partially obscured by edema.

Idiopathic Intracranial Hypertension A 39-year-old male presented to the BPEI ER with blurry vision in his right eye for 2 weeks. Examination revealed CF OD, 20/60 OS vision, right APD, and bilateral disc edema. OCT showed diffusely elevated RNFL thickness and HVF 30-2 was not able to be performed …

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.

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. …

Indirect Carotid Cavernous Fistula A 72-year-old female referred to Bascom Palmer Emergency room with 4 months of progressive painless diplopia and eye redness after dental procedure. Exam revealed VA 20/25 OU with bilateral abducens palsy, and arterialization of the conjunctival vessels. Review of…

Intracanalicular Optic Nerve Sheath Meningioma A middle-aged patient with a PMH of breast cancer, migraines, and hyperlipidemia presents to the Bascom Palmer ER with a chief complaint of headache and left eye blurry vision for the past month. Recent work-up outside is remarkable for normal laborato…

Juvenile Psammomatous Ossifying Fibroma An 18-year-old female presented with blurry vision, headaches for 4 months. She was diagnosed to have papilledema on an outside eye exam and referred to BPEI. Her visual acuity was 20/20 OD, 20/100 OS. Additionally, she was noted to have junctional scotoma on…

Leber Hereditary Optic Neuropathy – LHON An 18-year-old healthy man was evaluated in the eye emergency room for acute progressive painless vision loss in both eyes. First was affected a right eye and a six days later, left eye was affected too. Best-corrected visual acuity was 20/800 right eye an…