PMC3350282_01
Composite retinal nerve fiber layer OCT. Optical coherence tomography showing extent of disc swelling during clinical course. At presentation (magenta line), disc edema is mild in the right eye, but more severe in the left eye. One and three weeks later (red and blue lines), disc edema has increased to both eyes. After treatment with antibiotics (black line), disc edema has essentially resolved.
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fig1
Optical coherence tomography showed a retinal nerve fiber layer (RNFL) average thickness of 188 microns OS with concentric circumferential elevation and an average RNFL thickness of 118 OD with inferonasal elevation (Figure 1).
MRI of optic nerves. Merged axial T2 MRI at the level of the optic nerves shows significantly increased optic nerve sheath expansion near the globe (thin arrow), which extends through the course of the optic nerve sheath (thick arrow).
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fig2
Because his presentation was not consistent with papilledema, orbit MRI was performed, which showed increased optic nerve sheath fluid, especially posterior to the globes (Figure 2) and contrast enhancement of the optic nerve sheaths.
Composite of fundus appearances over time. Fundus photos showing extent of disc edema over time: at presentation (a, b), pretreatment with highest-grade edema (c, d), and posttreatment (e, f).
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Repeat testing two weeks after antibiotic treatment showed marked improvement in both his symptoms and the extent of disc edema (Figure 3).
Visual field examination before and after treatment. Humphrey visual field testing shows improvement and resolution of enlarged blind spot after antibiotic treatment.
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fig4
Visual field testing also improved after antibiotics, with resolution of the enlarged blind spot (Figure 4).