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Acute syphilitic posterior placoid chorioretinopathy (ASPPC) is a unique ocular sign of syphilis. It appears as a large, flat, yellowish lesion on the retinal pigment epithelium, typically in the macula. While not seen in every syphilis case, its presence strongly suggests ocular involvement and wa…

Orbital B-Cell Lymphoma in the Setting of Primary Open Angle Glaucoma A middle-aged patient was referred to BPEI after an Emergency Room visit for uncontrolled glaucoma. His outside ophthalmologist had been successfully managing the patient with topical medication and maintaining vision. Patient th…

Recurrent Idiopathic Neuroretinitis A patient presented with 1 day of decreased vision in 2016. Exam disclosed OS>>OD optic nerve edema with visual field defects without other findings. The patient was treated with steroids without much improvement and lost to follow up. The patient then over…

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…

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…

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…

Radiation Optic Neuropathy A patient with a history of proton beam therapy for a chordoma near the clivus presented with 1 week of blurry vision in the left eye. On presentation, patient’s exam was notable for a visual acuity of 20/25 in the right eye and 20/50 in the left eye. Intraocular pressu…

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…

Prothrombin G20210A Mutation and Hyperhomocysteinemia in Young Patient with Non-Arteritic Ischemic Optic Neuropathy A patient devoid of significant medical history presented with a sudden onset of painless vision loss in his right eye upon awakening. While the anterior segment appeared unremarkable…

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,…

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…

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 …

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…

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…

Adult-Onset Asthma with Periocular Xanthogranuloma A patient with a history of asthma and chronic sinusitis presented with unilateral facial swelling for three years. The facial swelling had gradually worsened over time. On examination, a well demarcated, yellow lesion was present in the right eyel…

Toxoplasma Papillitis A patient with a history of hypertension, hyperlipidemia, and COPD presented with 10 days of painless, progressive blurry vision of the right eye. On initial examination, the patient was found to have anterior chamber inflammation, vitreous inflammation, and a white retinal le…

Incipient Non-Arteritic Ischemic Optic Neuropathy A patient presented for routine follow up of age related macular degeneration and was found to have incidental optic disc edema in her right eye without any decrease in vision or other visual symptoms. On further testing she had enlarged blind spot …