[Skip to Navigation]
JAMA Ophthalmology Clinical Challenge
January 13, 2022

Bilateral Hemorrhagic Optic Disc Edema in a Middle-aged Man

Author Affiliations
  • 1Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
  • 2Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
JAMA Ophthalmol. 2022;140(3):280-281. doi:10.1001/jamaophthalmol.2021.3419

A 49-year-old man with a history of diabetes, hypertension, intravenous drug abuse, and multiple sexual partners presented to the emergency department with painless vision loss in both eyes for 10 days, left eye worse than right eye, and photophobia in both eyes. His visual acuity was count fingers OD and 20/70 OS. Intraocular pressure was 20 mm Hg OD and 16 mm Hg OS. There were 1+ (10-12 cells/high-power field) anterior chamber cells in both eyes with very hazy posterior pole details in the right eye and minimal vitreous haze in the left eye. There was a hazy view to the posterior pole in the right eye with disc edema and multiple flame hemorrhages surrounding the nerve. Examination of the posterior pole in the left eye revealed partial obstruction of all vessels and a complete halo on the disc with numerous flame hemorrhages emanating from and surrounding the optic nerve, along with a few dot blot hemorrhages within the macula (Figure). His blood pressure was 173/137 mm Hg, but the rest of his vital signs were normal.

Add or change institution