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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…

Arsenic Toxicity A patient presented for slowly worsening vision over past two years. She was diagnosed with glaucoma at an outside hospital however vision continued to worsen throughout the years. She presented for second opinion. Due to her posterior exam, her diagnosis was difficult to ascertain…

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…

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…

Ethambutol Induced Optic Neuropathy A patient with a past medical history of chronic Mycobacterium avium infection, on anti-mycobacterial medication for 5 months, presented with bilateral, painless, progressive visual loss for 1 month. Previous medical history significant for B cell lymphoma and ma…

This patient presented with a one day history of severe pain, reduced vision, diplopia, and proptosis. Imaging revealed a superior ophthalmic vein thrombosis. Extensive workup showed no definite underlying etiology. The patient was started on antibiotics, corticosteroids, and anticoagulation. There…

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 …

Idiopathic Intracranial Hypertension A patient with slow and progressive, painless, visual decline OD for two weeks presents to BPEI ED. She also notes moderate intensity full-day headaches and TVOs in the same time period. She saw an outside provider and was referred to BPEI ED for optic nerve hea…

Idiopathic Intracranial Hypertension A patient presented with two weeks of vision loss alongside a year-long complaint of left-sided neck stiffness and headaches. Past medical history was remarkable for end-stage renal disease on peritoneal hemodialysis. Examination was notable for blood pressure o…

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. …

Infiltrative Optic Neuropathy Secondary to Pleomorphic Mantle Cell Lymphoma A patient presented to the ophthalmology emergency room with a 2-day history of decreased vision of his left eye. Examination revealed vision of 20/25 OD and 20/50 OS, with a relative afferent pupillary defect in the left e…

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…

Leber's Hereditary Optic Neuropathy A patient came to ED due to subacute decreased vision in his right eye since 1/2023. He had a history of decreased vision in his left eye following phacoemulsification surgery in Oct 2022. BCVA was 20/70 OD and 20/400 OS Past medical history was positive for HTN,…

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…

A patient discovered to have infiltrative optic neuropathy secondary to pleomorphic mantle cell lymphoma. Color fundus photo of the left eye shows grade 3 optic nerve edema with associated splinter hemorrhages as well as a few, scattered dot blot hemorrhages.