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Bilateral optic disc swelling with blurring of the disc margins and retinal nerve fibre layer haemorrhages.

Case 23

Figure 1. Bilateral optic disc swelling with blurring of the disc margins and retinal nerve fibre layer haemorrhages.

Author: Simon Nothling     Editor: Adrian Fung

A 37-year old lady was referred from an optometrist with a two-week history of mild frontal headache and transient loss of vision.

Case history

A 37-year-old recently married lady was referred by her optometrist with a two-week history of mild frontal headaches and transient visual obscurations. She suffered obesity and weighed 146kg, having put on 5-10kg over the last year. There were no other associated symptoms such as diplopia, vomiting, fevers, speech disturbance or limb weakness. Past medical history included tonsillectomy. She had an Implanon® (etonogestrel, a steroidal progestin) contraceptive implant, but was on no other medications. She smoked 10-15 cigarettes daily.

Visual acuities were 6/6 unaided in both eyes (OU). Intraocular pressures were normal at 15mmHg OU. Blood pressure was 130/91mmHg. Both eyes were quiet with severely swollen optic discs causing blurring of the disc margins (Figure 1). Nerve fibre layer haemorrhages were present at both optic discs and spontaneous venous pulsations were absent. Both maculae were normal, and Ishihara colour vision testing was normal.

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