This 24YO male presented with these fundus findings. Both optic nerves were severely and diffusely swollen with a lipid star in the nasal macula. Blood pressure in the office was 224/145.
Learning Points:
The nasal macular lipid star originated from the optic nerve, where fluid and lipoproteins leaked into the surrounding tissues.
When the fluid is absorbed, the lipid precipitates out in Henle’s layer. This is also seen in other causes of optic nerve swelling or inflammation, including neuroretinitis.
The lipid supranasal to the right optic nerve is a bit unusual.
