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:

neuro_ophtho_24_1.png

Fundus examination was within normal limits. OCT imaging of the macula OS was performed and is shown below: 

neuro_ophtho_24_2.png

Question 1: Which of the following is an abnormality seen in the OCT image?

OCT RNFL analysis was also performed and is shown below:

neuro_ophtho_24_4.png

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:

  1. 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:

  1. To describe the characteristic OCT and infrared imaging findings of acute macular neuroretinopathy

  2. To list the main risk factors associated with the development of acute macular neuroretinopathy.