This patient presented with 20/200 vision OD with a severely swollen nerve, a secondary central retinal vein occlusion (CRVO), and a large patch of nasal macular neuroretinitis. The left eye was normal.
Three weeks later, the findings had improved spontaneously and dramatically, and vision was 20/50. Some faint superior and nasal lipid was noted.
Bloodwork for syphilis, Bartonella (cat scratch), and Lyme disease was negative.
Learning Points:
The diagnosis for a unilateral swollen nerve is extensive. However, it becomes much smaller when associated with inner retinal ischemia and lipid exudation (neuroretinitis), including cat scratch (Bartonella), Lyme disease, and syphilis.
When no underlying cause is found, the entity is called Leber’s idiopathic stellate neuroretinitis. The condition is self-limited, so treatment is not usually recommended.
