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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…

Leber Hereditary Optic Neuropathy An 18-year-old male presented to the ER with bilateral decreased vision and eye pain for 10 days. His visual acuity was HM OD, 20/300 OS. He was noted to have disc pallor OD and temporal pallor with slight nasal elevation OS on fundus exam. His MRI showed T2 hyper …

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…

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…

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 …

Miller Fisher Syndrome A patient with no significant PMH presented with acute onset of diplopia associated with loss of balance 2 weeks after having an influenza infection. On examination: a bilateral limitation in adduction with end gaze nystagmus in the abducted eye was noted. Also, dilated and n…

In this module, we will look at:




Anatomy / Pathways / Light Reflex


Optic Neuritis


Papilledema


NAION


Giant Cell Arteritis


Inherited Optic Neuropathies


Other Optic Neuropathies

Neuromyelitis Optica Spectrum Disorder (NMOSD) A patient presented to the emergency room with acute vision loss in the left eye for two weeks. Examination revealed 20/400 vision, crowded nerve with blurred margin, and afferent pupillary defect in the left eye. MRI orbit with and without contrast re…

Neuromyleitis Optica A child presented to the ER with blurry vision and eye pain. Exam disclosed unilateral optic nerve edema and decreased color vision; subsequent MRI disclosed optic neuritis. Lab testing demonstrated +Aqp4 antibodies, and the patient subsequently developed longitudinally extensi…

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…

Non-Arteritic Ischemic Optic Neuropathy We report a case of a 32-year-old male who presents with a four days blurry vision in the left eye. Patient denied any associated pain or systemic symptoms. His review of system includes mild gastrointestinal discomfort 2 years prior that led to eventual remo…

Non-Paraneoplastic Autoimmune Retinopathy (npAIR) A patient presented to the neuro-ophthalmology clinic for progressively decreasing vision in both eyes. He first noticed flashes and a blind spot in both eyes 3 months ago. Best-corrected visual acuity was 20/80 in the right eye and 20/50 in the lef…

Nuclear 3rd CN Palsy with Vertical Gaze Palsy A patient with significant vasculopathy risk factors (DM, HTN, dyslipidemia), had a stroke affecting the right thalamus, midbrain, and right cerebellum due to basilar artery occlusion. He had a successful mechanical thrombectomy with a stent retriever a…

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 patient with ocular Bartonella henselae infection manifesting as neuroretinitis and branch retinal artery occlusion.

Ocular Ischemic Syndrome Ocular ischemic syndrome (OIS) is a rare condition associated with severe carotid artery occlusive disease leading to ocular hypoperfusion. It typically presents at mean age of 65, there is no racial predilection, and is two times more common in men than women. It is typica…

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…