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Atypical Case of Non-Arteritic Ischemic Optic Neuropathy: Bilateral, Asymmetric Optic Disc Edema in a Vardenafil User
Poster Presentations
375
hypertension and diabetes. In addition, CWS may be found in many other disorders, which can be divided by etiology into ischemic, embolic, infectious, toxic, neoplastic, and immune-mediated, among others. A thorough case history, review of systemic health, and funduscopic evaluation are all necessary components for differentiating the proper cause of CWS. Case Report: A 43-year-old black male presented to the eye clinic with the complaint of central blur for approximately 2 days, O.D. . O.S. Medical history was positive for diabetes, hypertension, and osteoarthritis. Systemic medications included glyburide and lisinopril. Allergy medications included olmesartan and doxycycline. Last ocular examination was at the emergency room (ER) 1 day prior, where he was diagnosed with hypertensive retinopathy and told to follow-up with his primary care physician (PCP). Upon presentation at our office, it was noted that the palms of his hands were extremely pale. Unaided visual acuities were HM @ 5-feet O.D. (PH NI) and 20/100-1 O.S. (PH NI). Pupils, confrontation fields, and extraocular motilities were within normal limits. Anterior segment examination was unremarkable OU. Goldmann tonometry measured 20 mmHg O.D., O.S. Dilated fundus examination revealed a C/D ratio of 0.3 OU with intact neuroretinal rim. Posterior pole examination revealed exudates, CWS, and hemorrhaging O.D. . O.S., including a Roth spot O.D. Peripheral retina was intact OU. Subsequent lab work revealed severe anemia and pancytopenia. Following our examination, the patient was sent to the ER for further systemic evaluation and possible blood transfusion. At the ER, laboratory testing revealed AIDS and renal failure. Conclusion: Patients often present with a myriad of systemic conditions, which may have similar retinal pathologies. While CWS primarily signal a vascular disease, they are associated with other etiologies, including AIDS and anemia. Prompt and accurate detection and differentiation of ocular pathologies will assist in the proper comanagement of the patient with the PCP. This poster will contain fundus photography, CT scan, and laboratory testing.
and compression have been ruled out. Pre-disposing factors include diabetes, hypertension, elevated cholesterol, and sleep apnea. There are also precipitating drug factors that may contribute to NAION, including phosphodiesterase type 5 (PDE5) inhibitors. Case Summary: A 60-year-old male presented with sudden, painless significant visual loss in the right eye; he denied headaches, nausea, temporal artery pain, jaw claudication, and pain. Systemic history was positive for both hypertension and diabetes. Among the medications, the patient had a history of vardenafil use. Visual acuity in the right eye was 3/600, while acuity in the left eye was 20/25. Upon dilated examination, the patient was found to have small, asymmetrically edematous discs, with the right more significantly elevated. The patient was sent out for magnetic resonance imaging, blood work and temporal artery biopsy, all of which were unremarkable. The patient was then followed under the care of a retinal specialist and was concluded to have bilateral, asymmetric, non-arteritic optic neuropathy. Conclusion: Non-arteritic ischemic optic neuropathy is the most common cause of disc edema in individuals over the age of 60 and is most typically seen unilaterally. This patient was atypical in that the presentation of disc edema was simultaneous, though asymmetric. It has been documented that reduced blood flow contributes to the infarction present in NAION; use of erectile dysfunction medications such as vardenafil increase the risk of such occurrences, as they cause mild blood pressure decrease and smooth muscle relaxation. NAION is typically monitored, and is found to improve by 3 lines in 6 months in 43% of cases. This poster demonstrates a patient within the typical demographic of NAION, but uncommon presentation, and association with a risk factor that is growing in increasing awareness in relation to optic neuropathy.
Poster 68
Background: Conjunctival intraepithelial neoplasia (CIN) is a unilateral, premalignant condition. It usually presents in late adult life and affects fair-skinned individuals. Predisposing factors include exposure to sunlight, human papillomavirus, and AIDS. CIN may clinically appear as a fleshy mass or leukoplakia most often located at or near the limbus but can extend into the adjacent cornea. It is a part of a spectrum of ocular surface neoplasia ranging from mild dysplasia to full-thickness replacement with dysplastic cells. Standard treatment involves excision with cryotherapy but other modalities include the use of topical mitomycin C, 5-fluorouracil, and interferon alpha-2b. Case Report: A 61-year-old white man presented with a 4x4 mm gelatinous lesion at the inferonasal limbus with , 1 mm extension onto the cornea in the right eye.
Atypical Case of Non-Arteritic Ischemic Optic Neuropathy: Bilateral, Asymmetric Optic Disc Edema in a Vardenafil User Roselyn Ahua, O.D., and Jeffrey Joy, O.D., Veterans Affairs Medical Center, Salisbury, North Carolina Background: Non-arteritic ischemic optic neuropathy (NAION) is a condition of the optic nerve head whereby a presumed infarction of the anterior portion of the optic nerve causes neuropathy. The short posterior ciliary arteries, which supply the laminar and pre-laminar optic nerve head, have a reduction of circulation, resulting in loss of perfusion to the nerve. NAION is labeled as such when other etiologies, including demyelination, inflammation,
Poster 69 CIN....Not Just a Fancy Pinguecula Aria Murphy, O.D., and Susannah Marcus-Freeman, O.D., Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida
375
hypertension and diabetes. In addition, CWS may be found in many other disorders, which can be divided by etiology into ischemic, embolic, infectious, toxic, neoplastic, and immune-mediated, among others. A thorough case history, review of systemic health, and funduscopic evaluation are all necessary components for differentiating the proper cause of CWS. Case Report: A 43-year-old black male presented to the eye clinic with the complaint of central blur for approximately 2 days, O.D. . O.S. Medical history was positive for diabetes, hypertension, and osteoarthritis. Systemic medications included glyburide and lisinopril. Allergy medications included olmesartan and doxycycline. Last ocular examination was at the emergency room (ER) 1 day prior, where he was diagnosed with hypertensive retinopathy and told to follow-up with his primary care physician (PCP). Upon presentation at our office, it was noted that the palms of his hands were extremely pale. Unaided visual acuities were HM @ 5-feet O.D. (PH NI) and 20/100-1 O.S. (PH NI). Pupils, confrontation fields, and extraocular motilities were within normal limits. Anterior segment examination was unremarkable OU. Goldmann tonometry measured 20 mmHg O.D., O.S. Dilated fundus examination revealed a C/D ratio of 0.3 OU with intact neuroretinal rim. Posterior pole examination revealed exudates, CWS, and hemorrhaging O.D. . O.S., including a Roth spot O.D. Peripheral retina was intact OU. Subsequent lab work revealed severe anemia and pancytopenia. Following our examination, the patient was sent to the ER for further systemic evaluation and possible blood transfusion. At the ER, laboratory testing revealed AIDS and renal failure. Conclusion: Patients often present with a myriad of systemic conditions, which may have similar retinal pathologies. While CWS primarily signal a vascular disease, they are associated with other etiologies, including AIDS and anemia. Prompt and accurate detection and differentiation of ocular pathologies will assist in the proper comanagement of the patient with the PCP. This poster will contain fundus photography, CT scan, and laboratory testing.
and compression have been ruled out. Pre-disposing factors include diabetes, hypertension, elevated cholesterol, and sleep apnea. There are also precipitating drug factors that may contribute to NAION, including phosphodiesterase type 5 (PDE5) inhibitors. Case Summary: A 60-year-old male presented with sudden, painless significant visual loss in the right eye; he denied headaches, nausea, temporal artery pain, jaw claudication, and pain. Systemic history was positive for both hypertension and diabetes. Among the medications, the patient had a history of vardenafil use. Visual acuity in the right eye was 3/600, while acuity in the left eye was 20/25. Upon dilated examination, the patient was found to have small, asymmetrically edematous discs, with the right more significantly elevated. The patient was sent out for magnetic resonance imaging, blood work and temporal artery biopsy, all of which were unremarkable. The patient was then followed under the care of a retinal specialist and was concluded to have bilateral, asymmetric, non-arteritic optic neuropathy. Conclusion: Non-arteritic ischemic optic neuropathy is the most common cause of disc edema in individuals over the age of 60 and is most typically seen unilaterally. This patient was atypical in that the presentation of disc edema was simultaneous, though asymmetric. It has been documented that reduced blood flow contributes to the infarction present in NAION; use of erectile dysfunction medications such as vardenafil increase the risk of such occurrences, as they cause mild blood pressure decrease and smooth muscle relaxation. NAION is typically monitored, and is found to improve by 3 lines in 6 months in 43% of cases. This poster demonstrates a patient within the typical demographic of NAION, but uncommon presentation, and association with a risk factor that is growing in increasing awareness in relation to optic neuropathy.
Poster 68
Background: Conjunctival intraepithelial neoplasia (CIN) is a unilateral, premalignant condition. It usually presents in late adult life and affects fair-skinned individuals. Predisposing factors include exposure to sunlight, human papillomavirus, and AIDS. CIN may clinically appear as a fleshy mass or leukoplakia most often located at or near the limbus but can extend into the adjacent cornea. It is a part of a spectrum of ocular surface neoplasia ranging from mild dysplasia to full-thickness replacement with dysplastic cells. Standard treatment involves excision with cryotherapy but other modalities include the use of topical mitomycin C, 5-fluorouracil, and interferon alpha-2b. Case Report: A 61-year-old white man presented with a 4x4 mm gelatinous lesion at the inferonasal limbus with , 1 mm extension onto the cornea in the right eye.
Atypical Case of Non-Arteritic Ischemic Optic Neuropathy: Bilateral, Asymmetric Optic Disc Edema in a Vardenafil User Roselyn Ahua, O.D., and Jeffrey Joy, O.D., Veterans Affairs Medical Center, Salisbury, North Carolina Background: Non-arteritic ischemic optic neuropathy (NAION) is a condition of the optic nerve head whereby a presumed infarction of the anterior portion of the optic nerve causes neuropathy. The short posterior ciliary arteries, which supply the laminar and pre-laminar optic nerve head, have a reduction of circulation, resulting in loss of perfusion to the nerve. NAION is labeled as such when other etiologies, including demyelination, inflammation,
Poster 69 CIN....Not Just a Fancy Pinguecula Aria Murphy, O.D., and Susannah Marcus-Freeman, O.D., Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida