I'm Losing Vision in Both Eyes

A 54-year-old woman with 2 years of normal-tension glaucoma is referred for bilateral progressive visual loss. She is diagnosed with both normal-tension glaucoma and compressive optic neuropathy, with the NTG delaying the diagnosis of the compressive element. CON causes a painless, progressive decline in vision, often affecting central vision first. With CON, the optic nerves initially appear normal without edema unless the lesion is anterior or causes obstructive hydrocephalus. Gradual pallor of the optic nerve with thinning of the retinal nerve fiber layer and ganglion cell layer is expected if not treated. Because CON is generally reversible if found early, progressive painless vision loss is a sign of retrobulbar compression until proven otherwise.