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Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.
On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.
A dilated fundus examination was performed demonstrating the following:
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Neuro-Ophthalmology
Case 24
Contributor: Arshia Eshtiaghi (CC3)
Patient Presentation: A 22-year old woman presented to a neuro-ophthalmology clinic with a 2-week history of painless, blurred vision in the left eye. Four weeks prior, she experienced a bout of fever and cough; she tested positive for SARS-CoV-2 infection. On examination, vision was 20/20 OD and 20/25 OS. Pupils were equal and reactive to light with no RAPD. Humphrey 24-2 SITA-Fast visual field testing revealed a paracentral defect OS, as shown below:
Fundus examination was within normal limits. OCT imaging of the macula OS was performed and is shown below:
Question 1: Which of the following is an abnormality seen in the OCT image?
OCT RNFL analysis was also performed and is shown below:
Question 2: Which of the following is the most likely diagnosis?
Question 3: What other investigation may be useful in confirming the diagnosis?
Question 4: What is the most likely prognosis for her visual field defect?
Question 5: What is the next best step in management?
References:
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Bhavsar K V., Lin S, Rahimy E, et al. Acute macular neuroretinopathy: A comprehensive review of the literature. Surv Ophthalmol. 2016. doi:10.1016/j.survophthal.2016.03.003
Learning Objectives:
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To describe the characteristic OCT and infrared imaging findings of acute macular neuroretinopathy
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To list the main risk factors associated with the development of acute macular neuroretinopathy.
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