A Case of Bilateral Optic Edema in a 71 Year Old Diabetic

Abstract

A 71 year old Hispanic male with a past medical history of hypertension, type II diabetes mellitus, and bilateral anatomically narrow angles status post bilateral peripheral iridotomies presented with the complaint of “looking through a film.” The patient could still drive, work as a cashier, see his computer and television, and read with his glasses. It was worse in the morning and resolved when he washed his face. The patient denied headaches, jaw claudication, weight loss, and anorexia. Pt had no neurologic deficits including diplopia. The patients hemoglobin A1c 4 months prior to being seen was 7. The patient endorsed checking his blood sugars at home and most are less than 200. The patient routinely checks his blood pressure at home and it is usually 130s/70s. The patient’s best corrected visual acuity was 20/20 in each eye at distance, intermediate, and near. His Ishihara color test was 11/11 in each eye as well. His intraocular pressure was 13 in each eye with corneal thickness of 642 OD and 626 OS. There was no relative afferent pupillary defect in each eye, extraocular muscle movements were full, and his confrontation fields were full as well. His anterior segment exam was unremarkable except for nuclear sclerosis of each lens. The fundus examination was remarkable for bilateral optic disc swelling with heme off both optic discs. Fluorescein angiography demonstrated bilateral optic disc leakage. OCT showed a flat sensory retina in each macula. The patient had an emergent MRI that demonstrated diffuse loss of normal high T2 signal, but no intracranial mass was present. CRP and ESR were both within normal limits when accounted for the patient’s age. The patient’s papilledema improved on one month follow-up exam without intervention. Due to the patient’s history of diabetes, normal corrected visual acuity, reportedly well controlled blood pressure, and essentially unremarkable work-up, the patient was diagnosed with diabetic papillopathy.