Metamorphopsia: An Initial Manifestation Of Idiopathic Intracranial Hypertension

1. Siti Hajar Ayub¹
2. Visvaraja Subrayan¹

¹University Malaya Medical Centre, Kuala Lumpur, Malaysia

Purpose:
To report a case of Idiopathic Intracranial Hypertension(IIH) with metamorphopsia as an initial complaint.

Methods:
A 26-year-old woman had metamorphosia in both eyes for 3 weeks duration. She was myopic(-2.75OD, -2.50OS). She weighed 74kg, was 162cm tall with Body Mass Index(BMI) of 28.2. She had gained 5 to 7 kg in the past 7 months. Best Corrected Visual Acuity(BCVA) was 6/9+2 OD and 6/6 OS, with distortion on the Amsler grid bilaterally. Examination findings were normal except for papilledema in both eyes. The optic disc Optical Coherence Topography(OCT) showed increase in Retinal Nerve Fibre Layer(RNFL) thickness bilaterally. OCT of the macula, Humphrey Visual Field(24-2) and the Computed Tomography(CT) scans of the brain were normal. Lumbar puncture revealed opening pressure of 360mm CSF with normal indices. Acetazolamide was started orally.

Results:
Bilateral papilledema showed gradual regression with oral acetazolamide. The metamorphopsia improved.

Conclusions:
The diagnosis of IIH should be considered in patients with coexistence of metamorphopsia and papilledema although it is a rare concurrence.