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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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Retina
Case 49
Patient Presentation: A 9-year-old previously healthy girl presented with progressive, painless vision loss in her left eye over 2 weeks. Her past ocular history was unremarkable. A complete physical examination including a neurological assessment was within normal limits. Her BCVA was 20/20 OD and HM OS, and anterior segment examination was unremarkable. A dilated fundus exam was performed and the fundus image for the left eye is shown below:
Question: Describe the main findings.
On further questioning, her parents reported a large raccoon population in their neighborhood and the presence of raccoon stool on their porch.
Question: What condition are these findings consistent with?
OCT HD5 Line Raster was performed overlying the worm.
Question: What layer of the retina is the worm located?
OCT macula was performed in the left eye over the fovea and shown below:
Question: What is the main abnormality on this OCT?
Question: Which of the following is an appropriate treatment option for this patient?
With photocoagulation, the worm was found to be immobilized on fundus examination.
For more information, see case report: https://pubmed.ncbi.nlm.nih.gov/27434904/
Learning Objectives:
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Recognize features of DUSN that help distinguish it from other conditions causing unilateral vision loss.
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Recognize key features of early and late stage DUSN.
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Recognize the treatment options for DUSN.
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