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Case 14-4, Asymmetric Papilledema

Clinical Summary

A 43-year-old obese woman with a history of pseudotumor cerebri was taking acetazolamide 500 mg once daily. On examination, her visual acuity was 20/15 bilaterally. Dilated ophthalmoscopy (A, B) revealed elevation of the optic disc and blurred disc margins, greater in the right eye than the left, and no associated hemorrhage or arteriovenous abnormalities in either eye. There was no relative afferent pupillary defect.

Optical Coherence Tomography

Horizontal and vertical tomograms were acquired through the optic disc in both eyes. In the right eye (C), significant swelling of the disc was noted, with a complete loss of the physiologic cup, In contrast, the left eye (D) exhibited less edema and swelling which primarily affected the disc margins only. There was a relative preservation of the physiologic cup in this eye.

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