Bilateral Optic Disc Edema Secondary to Severe Vitamin A Deficiency: A Rare Cause of Acute Vision Loss

We report a rare case of bilateral optic disc edema in a patient found to have severe vitamin A deficiency. While vitamin A deficiency typically presents with optic disc atrophy, this case emphasizes the importance of considering vitamin A deficiency in patients with atypical optic disc edema.

A 39-year-old female with a history of disordered eating habits and extensive psychiatric history presented to the emergency department with acute-onset cloudiness and blurring of her vision bilaterally. Physical exam was notable for bilateral optic disc edema in the absence of increased intracranial pressure, as demonstrated by an unremarkable MRI and lumbar puncture opening pressure of 18 cm H₂O. Extensive testing on serum and cerebrospinal fluid was notable only for a serum vitamin A level of less than 5 μg/dL (normal: 38-98 μg/dL). The patient underwent inpatient hospitalization and was given 100,000 units of intramuscular vitamin A for 3 days with 50,000 units per day for the following 2 weeks. A follow-up visit 1 month later revealed resolution of her optic disc edema in the right eye and only mild optic disc edema in the left eye.

We describe a case of bilateral optic disc edema in a patient with severe vitamin A deficiency, underscoring the potential for nutritional abnormalities to present in this fashion. We also emphasize a multidisciplinary approach to unveil the underlying causes of atypical presentations of optic disc edema and create an appropriate treatment plan for patients with nutritional deficiencies.