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Ophthalmic Images
October 13, 2016

Optical Coherence Tomography Imaging of Paton Folds in Papilledema With Retinopathy From Systemic Hypertension

Author Affiliations
  • 1Bolton National Health Service Foundation Trust, Bolton, United Kingdom
JAMA Ophthalmol. 2016;134(10):e162121. doi:10.1001/jamaophthalmol.2016.2121

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.