What Is Not There In This Optic Nerve Head?

Ambika Selvakumar

Aim: To report an unusual conglomeration of various optic nerve disorders in the same patient.

Abstract: A thirty three year old female presented to us with headache and blurred vision in both eyes for two weeks . On examination she had 6/9,N6 vision, with established disc edema in both eyes with sectoral pallor in left eye. Her MRI Brain and orbit showed bilateral elevation of optic disc with nodular hyperintense signals, with widening of peri optic spaces. Her ocular USG revealed bilateral disc drusen. Her visual fields was suggestive of enlarged blind spot in the right eye and left eye revealed altitudinal field loss. Her BP was 220/140 mm Hg, opening CSF pressure was increased (400mm H2O). Subsequently she was found to be 10 weeks pregnant following infertility treatment! She was prescribed diuretics, steroids & acetazolamide with thorough counseling regarding the teratogenic effects and possibility of medical termination of pregnancy if fetal abnormality ensues.

Conclusion: A pregnant lady with malignant hypertension, bilateral disc drusen and papilledma secondary to Idiopathic intracranial hypertension, with ischemic optic neuropathy in left eye was a diagnostic surprise Considering the precious pregnancy we managed to maintain her vision and she subsequently delivered a healthy baby boy. On her last follow up she had 6/6, N6, 6/9 N6 vision respectively with resolving disc edema and pallor in both eyes.