Isolated congenital optic disc anomalies

This patient demonstrates bilateral tilted optic discs. Patients with this congenital optic disc anomaly may be asymptomatic or have bitemporal visual field defects that do not respect the vertical midline

Isolated congenital optic disc anomalies

This patient demonstrates bilateral tilted optic discs. Patients with this congenital optic disc anomaly may be asymptomatic or have bitemporal visual field defects that do not respect the vertical midline

Isolated Optic Neuritis/Neuropathy

Several Primary Mutations result in Leber's hereditary optic neuropathy, including mitochondrial deletions at positions 11778, 3460, and 14484. Although the 11778 is the most common mutation, the 11484 has the best prognosis for spontaneous recovery. This case exhibits the 3460 mutation.KBDinflammationlebersopticneuropath

Acquired Disc Changes

Although optociliary shunt vessels are venous collaterals that typically form in response to chronic venous obstruction, they may occur on a congenital basis as seen here.curriculum_fellow; KBDshuntvesselscongenital; KBDdooncongenita

Neuro-Ophthalmic Consequences of Therapy

radiation retinopathy may mimic diabetic or hypertensive optic neuropathy. A history of irradiation to the eye, orbit, or head is mandatory. Radiation retinopathy usually occurs many months after radiation therapy.KBDsysdisradiationretinopath

Optic tract syndrome due to carotid artery dolichoectasia

This 43-year-old man was referred for evaluation of 6 months of visual loss OU. In retrospect, he had noticed increasing difficulty with his tennis game dating back over 3 years, as balls would pass him unexpectedly when hit to his backhand (left) side. The patient did not think this was progressive. He had no headaches, no evidence of endocrine dysfunction or collagen-vascular disease, and no other past medical history. On examination he refracted to 20/20 OU and got 10/14 American Optical color plates correct in either eye, largely missing left-sided characters. He had a 0.6 log unit afferent pupillary defect, and a dense (no HM) congruous left homonymous hemianopsia sparing the central 2 degrees. ""Bow-tie"" atrophy was present. The rest of the neurologic examination was normal.curriculum_fellow; KBDdolichoectasi

Traumatic internal carotid artery dissection

Traumatic dissection of the carotid artery may result in neck pain, an ipsilateral Horner's syndrome (disruption of the pericarotid sympathetic fibers), or ipsilateral arterial occlusions from embolic disease. Pair with images 91_18 and 91_20.curriculum_fellow; KBDcarotiddissectio

Neuro-Ophthalmic Imaging-MRI

Aneurisms may result in neuro-ophthalmologic sign and symptoms by direct compression of the afferent or efferent systems or by the secondary effects of hemorrhage. Basilar aneurisms may result in ocular motor deficits such as a unilateral or bilateral third nerve palsy

Orbital Tumors

This 30-year-old man had a retrobulbar intraconal mass OS. The CT scans showed a heterogeneous lobulated enhancing mass, 2.2 x 1.9 x 1.8 cm. The case beautifully exhibits chorodial folds. The ultrasound showed internal reflectivity. The patient refused surgery. Pair with Images 97_60, 97_62, 97_63, and 97_64.CFopticnervetumor

Chiasmal Syndromes

This 36-year-old woman presented in 1988 with 3 weeks of vertical binocular diplopia. She was a known amblyope OD. Her examination was notable for a right hyperdeviation of 1 PD present in right gaze and a subtle left noncongruous homonymous field defect. She was lost to follow-up, but 5 years later she re-presented with a loss of vision OS to hand motions, a subtle temporal depression, OD, and conjunctival nodules that, upon biopsy, showed noncaseating granulomas. Her motility was normal. The MRIs shown here were done at this time. With corticosteroid therapy, she recovered her acuity to 20/20 OS.curriculum_fellow; KBDotherinflammatorysarcoid; KBDsysdissarcoidosi