A man in his 30s with an unremarkable medical history presented with a 2-day history of headache and blurred vision. Visual acuity was 20/20 OD and 20/25 OS. Ophthalmoscopy revealed bilateral papilledema with retinal hemorrhages and nerve fiber layer infarcts. In addition, concentric wrinkles radiating from the left optic disc were observed. The presenting blood pressure was 240/166 mm Hg and, combined with end-organ damage, systemic hypertensive emergency was diagnosed.
Retinal imaging temporal to the disc demonstrated undulating folds in a “hill-valley” or sawtooth pattern involving the superficial layer of the neurosensory retina (Figure). Visual acuity recovered to 20/20 bilaterally with resolution of all retinal folds following control of systemic hypertension by oral medications.
Kim MJ, Kelly SP. Optical Coherence Tomography Imaging of Paton Folds in Papilledema With Retinopathy From Systemic Hypertension. JAMA Ophthalmol. 2016;134(10):e162121. doi:10.1001/jamaophthalmol.2016.2121