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Patient presents with unusual case of unilateral disc edema

Healio Ophthalmology5d ago1 min read

A 35-year-old woman was referred by her optometrist for a neuro-ophthalmology evaluation for left optic disc edema and transient visual symptoms in the left eye.Her medical and ocular histories were notable for elevated BMI but were otherwise unremarkable. She was not taking any prescribed or over-the-counter medications at that time.Approximately 1 year before presentation, she began experiencing severe left retro-orbital pain that gradually decreased in severity over several months but otherwise remained. At the same time, she began experiencing intermittent, transient episodes of blurred

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AI Summary

Quick Take

A 35-year-old woman with an elevated BMI presented with unilateral left optic disc edema and a year-long history of persistent retro-orbital pain. Despite the lack of systemic medication use, her symptoms included intermittent blurred vision, prompting a neuro-ophthalmology referral to investigate the underlying cause of the localized swelling.

Why It Matters

Unilateral disc edema in a patient with an elevated BMI presents a diagnostic crossroads, as idiopathic intracranial hypertension (IIH) typically manifests bilaterally. This case underscores the importance of a detailed symptom timeline; the patient's retro-orbital pain had persisted for a full year before the referral, which may point away from acute inflammatory events and toward more chronic compressive or vascular etiologies. For the primary eye care provider, recognizing when a presentation deviates from the 'textbook' IIH profile is critical for appropriate subspecialty triaging.

Key Details

Patient is a 35-year-old female with an elevated BMI and no other significant medical or ocular history.
Clinical presentation involves unilateral left optic disc edema and transient blurred vision.
The patient reported severe left retro-orbital pain starting 12 months prior, which has since decreased in severity but remains present.
No prescribed or over-the-counter medications were being taken at the time of evaluation, ruling out common drug-induced disc swelling.
The case was referred from primary optometric care to neuro-ophthalmology for specialized diagnostic workup.

Practice Implications

When unilateral disc edema is observed, clinicians should perform a deep dive into the patient's history of pain and visual transients. In patients with high BMI, while IIH is a top differential, the presence of strictly unilateral signs and long-standing retro-orbital pain necessitates imaging and neuro-ophthalmic consultation to rule out orbital or optic nerve sheath pathology.

Who's Affected

OptometristsNeuro-ophthalmologistsComprehensive Ophthalmologists

Evidence StrengthPreliminary

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