June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Characterizing optic disc edema in the setting of neurosyphilis
Author Affiliations & Notes
  • John Jing-Wei Chen
    Ophthalmology, Mayo Clinic, Rochester, MN
  • Matthew Thurtell
    Ophthalmology, University of Iowa, Iowa City, IA
  • Footnotes
    Commercial Relationships John Chen, None; Matthew Thurtell, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 3881. doi:
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      John Jing-Wei Chen, Matthew Thurtell; Characterizing optic disc edema in the setting of neurosyphilis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3881.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

Syphilis can affect any part of the eye, including the optic nerve. Patients can have disc edema without visual compromise, which has been attributed to papilledema from raised intracranial pressure or optic perineuritis from optic nerve sheath inflammation. However, these attributions were proposed before MRI was largely available. We performed a retrospective, clinical observational study to better understand the mechanism of optic disc edema in neurosyphilis.

 
Methods
 

We reviewed all patients seen at the University of Iowa from 2010 to 2014 with a diagnosis of neurosyphilis affecting the optic nerve, which revealed three patients with optic disc edema. The visual acuity, fields, OCT, fundus photos, lumbar puncture, and MRI results were examined to determine the mechanism of the optic disc edema. Neurosyphilis was confirmed with reactive VDRL in the CSF.

 
Results
 

One patient had unilateral optic disc edema and two patients had bilateral optic disc edema. The visual fields showed enlargement of the blind spots only, except for one eye of a patient who had concomitant chorioretinitis and trace optic disc edema resulting in a cecocentral scotoma. All three patients denied symptoms of raised intracranial pressure. The opening pressure was normal in the two patients who had it measured; the opening pressure in the patient with unilateral disc edema was not measured. MRI of the orbits demonstrated no optic nerve sheath enhancement in any of the patients.

 
Conclusions
 

With modern diagnostic imaging, we were able to demonstrate a lack of optic nerve sheath enhancement in three patients with optic disc edema and preserved visual function, suggesting papillitis may be a better term than optic perineuritis in many cases of isolated disc edema from neurosyphilis.  

 
62 year-old male with bilateral optic disc edema in the setting of neurosyphilis. The right eye has severe optic disc edema with normal visual fields other than enlargement of the blind spot. The left eye has a cecocentral scotoma due to chorioretinitis in conjunction with trace optic disc edema. OCT shows an elevated retinal nerve fiber layer thickness in both eyes, right greater than left, and photoreceptor disruption in the macula of the left eye confirming chorioretinitis. Magnetic resonance imaging of the orbit demonstrates no optic nerve or sheath enhancement.
 
62 year-old male with bilateral optic disc edema in the setting of neurosyphilis. The right eye has severe optic disc edema with normal visual fields other than enlargement of the blind spot. The left eye has a cecocentral scotoma due to chorioretinitis in conjunction with trace optic disc edema. OCT shows an elevated retinal nerve fiber layer thickness in both eyes, right greater than left, and photoreceptor disruption in the macula of the left eye confirming chorioretinitis. Magnetic resonance imaging of the orbit demonstrates no optic nerve or sheath enhancement.

 
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