This healthy 35YO male presented with recent severe vision loss in his right eye. Vision was counting fingers OD and 20/20 in his normal OS.
Optos color RG imaging shows moderate optic nerve swelling, which is confirmed by OCT. There is moderate nerve leakage on fluorescein angiography. Bloodwork, including syphilis and Bartonella, was negative, so he was observed without treatment.
One month later, vision improved to 20/200. The disc edema was markedly improved, and new lipid radiated nasally from the macular center. Three months later, the disc edema was fully resolved with secondary atrophy, and the lipid was decreasing. Vision was 20/25.
Learning Points:
The diagnosis for a unilateral swollen nerve is extensive. However, it becomes much smaller when associated with acute inner retinal ischemia (not seen in our case) and, later, with lipid exudation within Henle’s layer (neuroretinitis), including cat-scratch (Bartonella) and syphilis. When no underlying cause is found, as in our patient, the entity is called Leber’s idiopathic stellate neuroretinitis.
