Karen McHugh, CRA, Eye Surgery Associates, Hollywood, Fla.
A 13-year-old girl from Haiti with no previous remarkable medical history presented with severe headaches, nausea and vomiting. Before coming to Florida, the patient was seen in Haiti by several physicians, but she found no relief with various oral medications. Visual acuity was 20/40 in both eyes.
Confrontation fields showed marked constriction in both eyes. Pupils were mid-dilated and sluggish. Humphrey visual fields of both eyes were markedly constricted. Motility and slit-lamp exams were within normal limits. Funduscopic exam revealed optic nerve edema, peripapillary flame hemorrhages, venous engorgement, macular star and macular edema in both eyes. The patient had had no contact with cats. All test results came back negative except for a lumbar puncture with a pressure greater than 56 centimeters of water. A magnetic resonance angiogram was performed and was normal.
The patient was diagnosed with idiopathic intracranial hyper-tension with papilledema due to increased intracranial pressure. An optic nerve sheath fenestration was done in both eyes. At last exam, visual acuity was 20/20 in both eyes with no evidence of optic nerve edema, but visual fields remained the same.
Blink is edited by Richard E. Hackel, MA, CRA, FOPS.