Dragnet

A 24-year-old previously healthy woman with a high body mass index presented with a several week history of poor vision in the left eye associated with non-positional headaches. Examination was notable for Frisén grade 2 bilateral optic disc swelling with a visual acuity of 20/20-1 in the right eye and 20/100+1 in the left eye and no relative afferent pupillary defect. Magnetic resonance (MR) imaging and MR venography of the brain were negative for a mass or venous sinus thrombosis. Lumbar puncture opening pressure was elevated, and the cerebrospinal fluid constituents were bland. A diagnosis of idiopathic intracranial hypertension was made; however, despite improvement in the papilledema with oral acetazolamide the vision continued to be reduced in the left eye. Macular optical coherence tomography confirmed a juxtapapillary choroidal neovascular membrane extending into the macula. The evaluation and various causes of visual loss in the setting of papilledema are discussed.