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Photo Essay
October 2002

Optic Nerve Cysticercosis

Arch Ophthalmol. 2002;120(10):1408-1409. doi:10.1001/archopht.120.10.1408

A 30-YEAR-OLD man sought treatment for diminution of vision of 10 days' duration in his left eye. Visual acuity was 20/20 OD and 20/80 OS. He had pain on ocular movement in the left eye and a left afferent pupillary defect. Fundus examination of the left eye showed optic disc edema (Figure 1A). Combined vector ultrasonography (Figure 2A) and magnetic resonance imaging (Figure 3A) findings were consistent with previously published findings in optic nerve cysticercosis.1,2 Perimetry showed an absolute inferior visual field defect in the left eye (Figure 4A). A serum enzyme-linked immunosorbent assay for cysticercosis was positive. In view of the severe optic nerve inflammation, the patient was treated with intravenous dexamethasone sodium phosphate injection (dosage, 100 mg daily for 3 days), then switched over to oral steroids. The patient regained visual acuity of 20/20 OS within 3 days and remained stable at 3 months of follow-up. Optic disc edema (Figure 1B) and the visual field defect (Figure 4B) showed rapid, progressive improvement and stabilized 2 weeks after treatment began. Ultrasonography at the 3-month follow-up visit revealed uniformly high reflectivity in the cyst, indicating the calcific process in the dead cyst (Figure 2B), and magnetic resonance imaging showed a reduction in the size of the cyst (Figure 3B).

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