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Article
June 1981

Granulomatous Optic Neuropathy

Author Affiliations

From the Department of Ophthalmology, Albany Medical College, Albany, NY.

Arch Ophthalmol. 1981;99(6):1053-1055. doi:10.1001/archopht.1981.03930011053014
Abstract

• A 24-year-old woman was seen with painless, progressive, unilateral visual acuity loss, optic nerve swelling, and opticociliary shunt vessels. Results of a skull series and conventional tomography showed enlargement and erosion of the optic canal. In addition, computed tomography (CT) disclosed a thickened optic nerve consistent with optic nerve sheath meningioma. A preoperative diagnosis of granulomatous optic neuropathy was based on the presence of mild posterior uveitis, "snowball" opacities in the vitreous ("string of pearl" sign), and a slightly elevated angiotensin-converting enzyme level. A specimen from a biopsy by means of a craniotomy indicated granulomatous optic nerve involvement with chiasmal invasion. The systemic effects of steroids for six months resulted in a modest improvement of visual acuity and restoration of normal optic nerve structure on repeated CT.

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