NOVEL - Emory Eye Center
 
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1 Toxoplasmic Chorioretinitis with Unilateral Disc EdemaA 53-year-old man had a history of high myopia and a seronegative spondyloarthropathy treated with immunosuppressive agents. He presented with mild, painless vision loss in his right eye. His examination showed findings of a right anterior optic neuropathy: visual acuity: 20/20 OD (right eye), 20/20...Rahul A. Sharma, MD, MPH; Nancy J. Newman, MD; Valérie Biousse, MD
2 Nonfunctiong Pituitary Adenoma with Chiasmal CompressionThis is a case of large non-functioning pituitary adenoma with mass effect on the optic chiasm inducing loss of optic nerve fibers and subsequent visual field. Figure 1: Fundus photographs demonstrating bilateral temporal optic nerve head pallor Figure 2: Humphrey visual fields demonstrating a bitem...William Pearce, MD; Valérie Biousse, MD
3 Geniculate Nucleus Metastasis with Homonymous SectoranopiaThis is a case of multiple brain metastases in the setting of bladder cancer complicated with right homonymous horizontal sectoranopia. Figure 1: Pet-scan showing liver (yellow arrows) and kidneys (red arrow) metastases Figure 2: Goldmann Visual Fields: Right homonymous horizontal sectoranopia Figu...Rabih Hage, MD; Valérie Biousse, MD
4 Artifact from Incomplete Orbital Fat Suppression on Magnetic Resonance ImagingOrbital fat has short relaxation times that results in a hyperintense appearance on T1-weighted magnetic resonance imaging (MRI). Fat suppressed T1 MRI sequences are needed to remove the fat signal and better visualize the orbital anatomy, including the optic nerve. Contrast can be used with fat sup...Matthew Boyko, MD; Valérie Biousse, MD
5 Ocular Fundus ExaminationReview of various techniques of ocular fundus examination, including direct ophthalmoscopy, binocular indirect ophthalmoscopy, slit lamp binocular indirect ophthalmoscopy, and fundus photography. Advantages and disadvantages of each technique are discussed.Devin D. Mackay, MD; Valérie Biousse, MD
6 Fundus AutofluorescenceThe retinal pigment epithelium (RPE) has many important functions including phagocytosis of the photoreceptor outer segments. The metabolism of the photoreceptor outer segments leads to the formation of lipofuscin. Disease states and potentially increased oxidative damage can lead to the buildup of ...Jonathan A. Micieli, MD; Valérie Biousse, MD
7 Optical Coherence Tomography of the Retinal Nerve Fiber LayerA normal optical coherence tomography (OCT) of the macula is shown highlighting the position of a single retinal ganglion cell and its axon in the retinal nerve fiber layer (Figure 1). The topographical relationship of retinal ganglion cells in the retina to the visual field and position in the ante...Jonathan A. Micieli, MD; Valérie Biousse, MD
8 Ganglion Cell Layer Analysis by Optical Coherence Tomography (OCT)A normal optical coherence tomography (OCT) of the macula is shown (Figure 1) and the various layers of the retina are labelled (Figure 2). The cell bodies of retinal ganglion cells (RGC) are located in the ganglion cell layer (GCL) of the retina and mostly synapse in the lateral geniculate nucleus ...Jonathan A. Micieli, MD; Valérie Biousse, MD
9 Normal Retinal AnatomyNormal posterior vitreous, retinal and chroroidal anatomy (pictures, fluorescein angiography and optical coherence tomography). Figure 1: Normal fundus photograph of the left eye o a : Optic disc and fovea o b : Foveal reflex in young patients o c : Macular and foveal areas share the same center o d...Rabih Hage, MD; Valérie Biousse, MD
10 Choroidal Hypoperfusion Defect in Giant Cell ArteritisHere, we present a case of a 62 year-old male with vision loss in the right eye, headaches, and neck/shoulder/temporal pain, found to have choroidal hypoperfusion and diagnosed with giant cell arteritis (GCA). In combination with anterior ischemic optic neuropathy and cotton wool spots, choroidal hy...Nithya Shanmugam; Michael Dattilo; Valerie Biousse
11 Optic Nerve Head Granuloma from SarcoidosisWe present a case of optic neuropathy with optic nerve head granuloma as the presenting sign of neurosarcoidosis. Initial patient presentation was notable for a chronic cough and worsening of vision in the left eye. Subsequent imaging revealed multiple brain lesions and the presence of a subcarinal ...Nithya Shanmugam; Valerie Biousse
12 Right Occipital Arteriovenous Malformation presenting as a Migraineous Visual AuraMigraine with visual aura is a distinct entity from a migraineous visual aura. A migraine with visual aura is characterized by a visual aura that does not prefer either visual field and accompanies a headache. The mechanism of the visual aura is via cortical spreading depression. A migraineous visua...Nithya Shanmugam; Fernando Labella; Valerie Biousse
13 Second Order Horner Syndrome Revealing Metastatic Squamous Cell CarcinomaHorner Syndrome is secondary to a lesion of the ipsilateral sympathetic pathway and is associated with ptosis, miosis, and anhidrosis. Here, we present a unique presentation of metastatic squamous cell carcinoma in a patient with a right-sided Horner Syndrome (second order). We also highlight the di...Nithya Shanmugam; Michael Dattilo; Valerie Biousse
14 Typical Idiopathic Intracranial Hypertension: Optic Nerve Appearance and Brain MRI FindingsA 24-year old African American woman was referred for bilateral optic disc edema that was incidentally noted on a routine eye examination. She had excellent visual function and dilated examination showed bilateral optic disc edema with peripapillary wrinkles in the right eye and pseudodrusen in the ...Jonathan A. Micieli, MD; Valérie Biousse, MD
15 Colloid Cyst HydrocephalusThis is a case of colloid cyst of the third ventricle complicated by severe hydrocephalus, raised intracranial pressure and papilledema. Figure 1: Fundus photographs demonstrating bilateral optic nerve head edema Figure 2a and 2b: T1-weighted axial brain MRI without contrast: Dilation of both later...Rabih Hage, MD; Valérie Biousse, MD
16 Large Sellar and Suprasellar Mass (Pituitary Macroadenoma) With Left Third Nerve Palsy and Left Optic Tract CompressionA case of a large sellar and suprasellar pituitary macroadenoma with an associated left third nerve palsy and left optic tract compression. Images from an MRI of the brain with contrast illustrate the imaging characteristics and extent of the tumor. Figure 1 : Humphrey Visual Fields (24-2 SITA-Fast)...Devin D. Mackay, MD; Valérie Biousse, MD
17 Metastatic Ovarian Cancer to the Left Occipital Lobe With Complete Right Homonymous HemianopiaA case of metastatic ovarian cancer to the left occipital lobe with a complete right homonymous hemianopia. Humphrey visual fields as well as images from an MRI of the brain are included. Figure 1 : Humphrey visual fields showing a complete right homonymous hemianopia Figure 2 : MRI brain T1 axial...Devin D. Mackay, MD; Valérie Biousse, MD
18 Vertical Diplopia Secondary to Skew Deviation With Ocular Tilt Reaction With Multiple Posterior Fossa MetastasesThis is a case of multiple brain metastases in the posterior fossa resulting in a skew deviation. Figure 1 : Photograph of the patient demonstrating a spontaneous right head tilt. The patient's head is tilted toward his right shoulder to suppress his diplopia Figure 2 : Ocular movements : There is a...Rabih Hage, MD; Valérie Biousse, MD; Jason Peragallo, MD
19 Fourth Nerve SchwannomaThis is a case of IVth cranial nerve schwannoma, showing an enhancement in the subarachnoid space consistent with the clinical presentation. Figure 1a : T1-weighted axial brain MRI Figure 1b : T1-weighted axial brain MRI : magnification of the brainstem Figure 1c : T1-weighted axial brain MRI : cr...Rabih Hage, MD; Valérie Biousse, MD
20 Large Frontal Meningioma with Mass Effect and Increased Intracranial PressureThis is a case of frontal meningioma presenting with raised intracranial pressure and bilateral papilledema responsible for visual loss. Figure 1: Goldmann visual field of the left eye. In the right eye, there was no response to the V4e. The visual field is severely constricted in the left eye. Fig...Rabih Hage, MD; Valérie Biousse, MD
21 Optic Disc Pseudoedema Due to Leber Hereditary Optic NeuropathyA 23-year-old woman developed sequential painless central vision loss in both eyes (right eye 5 months ago and left eye 2 months ago). Her examination showed bilateral optic neuropathies: visual acuity: 20/300 eccentrically OU (no improvement with pinhole); pupils: equal and reactive with no relativ...Rahul A. Sharma, MD, MPH; Valérie Biousse, MD
22 Retrograde Trans-Synaptic Degeneration from a Longstanding Occipital Lobe TumorThis is an illustrated guide that (1) discusses the localization of paracentral homonymous hemianopic scotomatous visual field defects and (2) discusses the concept of trans-synaptic retrograde degeneration. A 43-year-old woman was assessed for longstanding blurred vision in both eyes. Her examinati...Rahul A. Sharma, MD, MPH; Valérie Biousse, MD
23 Incipient Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION)A 61-year old white man with hypertension, diabetes, and dyslipidema was seen in neuro-ophthalmology consultation for asymptomatic right optic disc edema. He had a small, crowded optic disc in the left eye known as a "disc-at-risk" (Figure 1). He had normal visual function including normal 24-2 SITA...Jonathan A. Micieli, MD; Valérie Biousse, MD
24 Sequential Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION)A 68-year old woman with hypertension, obstructive sleep apnea and obesity was seen in neuro-ophthalmology consultation for vision loss in the right eye. She had right optic disc edema with a small optic disc hemorrhage a small, crowded optic disc in the left eye known as a "disc-at-risk" (Figure 1)...Jonathan A. Micieli, MD; Valérie Biousse, MD
25 Typical Idiopathic Optic NeuritisThis is a case of a typical optic neuritis in a 41-year-old woman presenting with vision loss and pain with eye movements in the right eye. Optic disc photos at presentation showed subtle hyperemia in the right eye (Figure 1) and optical coherence tomography (OCT) of the retinal nerve fiber layer (R...Jonathan A. Micieli, MD; Valérie Biousse, MD
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