This 17YO presented with 20/200 vision OD and diffuse optic disc edema with temporal peripapillary retinitis, peripapillary inner retinal blood, a few areas of focal inner retinitis, and a prominent macular lipid star. The left eye was normal.
Our patient tested positive for Bartonella and had a cat (should’ve gotten a dog and opted for a Toxocara worm instead…).
Patients will usually improve without treatment, although antibiotic therapy may sometimes be recommended.
Learning Points:
Optic nerve inflammation, often from malignant hypertension or neuroretinitis, can cause fluid and blood to leak into the optic nerve and peripapillary tissues. When the fluid absorbs, the lipid can precipitate in Henle’s layer, creating the lipid star.
There are numerous causes for neuroretinitis, including cat scratch (Bartonella), Lyme disease, syphilis, and idiopathic (Leber’s stellate neuroretinitis).
