A 17-Year-Old With an Abnormal Optic Disc

Rod Foroozan, MD


November 16, 2016

Clinical Presentation

A 17-year-old boy was noted to have an abnormal appearance of the optic disc in his left eye. He was asymptomatic and had had a dilated eye examination after receiving a glasses prescription.

The patient does not drink alcohol or smoke tobacco. He has no family history of vision loss and is currently taking no prescription medications. He has had no fever, chills, night sweats, or suggestion of systemic infection, and no history of rash or sexually transmitted diseases.

Visual acuity was 20/20 in both eyes. Color vision with Ishihara pseudoisochromatic plates was 10/10 in both eyes. Pupils were brisk in each eye, with no relative afferent pupillary defect. Automated perimetry (Figure 1) showed a few points of reduced sensitivity in the right eye in no specific pattern and a few points of decreased sensitivity around the left blind spot. Intraocular pressures were 15 mm Hg in each eye.

Slit-lamp examination of the anterior segment was normal. Funduscopic examination (Figure 2) demonstrated a normal right optic disc and an area of whitening, more so inferiorly, involving the left optic disc. This area of whitening was slightly elevated. Intravenous fluorescein angiography is shown in Figure 3.

Figure 1. Automated perimetry showing a few points of decreased sensitivity in the right eye and a slightly enlarged blind spot in the left eye.

Figure 2. Funduscopy showing a normal right optic disc. The inferior portion of the left optic disc showed whitening.

Figure 3. Intravenous fluorescein angiography showing leakage involving the superior and inferior nasal branches of the retinal arterioles of the left eye. The area of whitening of the left optic disc was hypofluorescent in the early phases, with very mild leakage in later phases. Latest phases are not shown.


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