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JAMA Ophthalmology Clinical Challenge
April 28, 2022

Bilateral Papilledema and Intact Vision With Normal Intracranial Pressure

Author Affiliations
  • 1Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
  • 2Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
  • 3Department of Neurology, Mayo Clinic, Rochester, Minnesota
JAMA Ophthalmol. Published online April 28, 2022. doi:10.1001/jamaophthalmol.2022.0261

A 23-year-old woman presented with 6 months of intermittent bilateral retro-orbital pain associated with blurred vision and wavy lines in the vision of both eyes, followed by worsening numbness and tingling of her hands and legs. Medical history was notable for mild obesity (body mass index of 30 [calculated as weight in kilograms divided by height in meters squared]).

Visual acuity was 20/20 OU, with briskly reactive pupils OU and no relative afferent pupillary defect. Intraocular pressure was 17 mm Hg OU. Ishihara color plates were 13/13 OU. Extraocular movements were full. Ophthalmoscopic examination revealed blurring and elevation of the nasal margins of the optic disc consistent with grade 1 optic disc edema in both eyes (Figure). Optical coherence tomography showed an elevated mean peripapillary retinal nerve fiber layer thickness of 170 μm OD and 150 μm OS. Automated visual fields demonstrated subtle enlargement of the blind spots.

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    1 Comment for this article
    By definition the term papilledema is reserved for increased intracranial pressure
    David Rodman, MD | SUNY/Buffalo
    A better title for this article would have substituted papilledema for disc edema, or simply mention POEMS