A 44-year-old woman with a medical history of depression and ocular history of mild myopia presented for LASIK evaluation. Her best-corrected visual acuity was 20/20 in both eyes, but examination revealed a swollen optic disc in the left eye. LASIK surgery was deferred and she was referred for evaluation of the unilateral optic nerve head swelling. She recalled minor head trauma three months earlier. Systemic review of symptoms was negative except for a subjective sensation of tingling of left side of her head and earlobe. She denied pain and decreased vision.
The patient had a history of depression and mild myopia. As mentioned above, she did note a minor trauma to her head three months earlier for which she did not receive any treatment. She denied any history of vision loss, eye pain or systemic neurologic symptoms (weakness, numbness, paralysis). She smoked one pack of cigarettes per day for 30 years, described minor social alcohol use and no other drug use. Medications included only Escitalopram (Lexapro) 10 mg daily. She had no family history of systemic problems.
Examination showed a best corrected visual acuity of 20/20 in each eye. Pupil examination noted 1 mm of anisocoria that was the same in light and dark with no afferent pupillary defect. Applanation intraocular pressures were 18 mmHg and 15 mmHg. She had full ocular motility, full confrontational fields and color plate testing was full. Hertel measurements were 15 mm OD and 16 mm OS with a base of 105 mm. She denied red desaturation. Anterior segment examination revealed normal findings. Fundus examination of the right eye revealed 1+ hyperemia without disc elevation. The left eye was noted to have 3+ disc elevation and 3+ hyperemia without visible drusen, but both eyes were otherwise within normal limits (See Figure 1). Her blood pressure was 122/66.
|Figure 1. The right eye showed 1+ hyperemia without disc elevation. The left eye was noted to have 3+ disc elevation and 3+ hyperemia without visible drusen. Both eyes were otherwise within normal limits.|