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Pediatric Idiopathic Intracranial Hypertension (Pediatric IIH) A pediatric patient accompanied by their parent presented to BPEI ED complaining of an episode of complete loss of vision in the left eye that was initially blurry, then totally black, lasting from 20-30 seconds. The symptom was associa…

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…

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…

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

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…

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…

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…

In this module, we will look at:




Anatomy / Pathways / Light Reflex


Optic Neuritis


Papilledema


NAION


Giant Cell Arteritis


Inherited Optic Neuropathies


Other Optic Neuropathies

Myelin Oligodendrocyte Glycoprotein Antibody Disease A middle-aged patient was referred from an outside facility for follow up of idiopathic intracranial hypertension. On careful review, she was found to have demyelinating disease on a prior MRI. Patient underwent a repeat MRI which did not demonst…

Morning Glory Disc Anomaly A child presented for evaluation of chronic poor vision of her right eye. Fundus exam showed an excavated nerve with peripapillary chorioretinal pigmentation, overlying central glial tuft, radial vessels, and inferior serous retinal detachment. Findings were consistent wi…

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…

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.

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

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,…

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…

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…

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.