Extended History

  • Possibly two significant findings
    1. The patient had a vaccination for the Swine Flu 2 weeks earlier.
    2. Possible sleep apnea.

Follow-up

  • Internist reports no new relevant findings.
  • Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP) noted to be in normal range.
  • BCVA: Decreased from 20/30 to 20/200 OS.
  • MRI within normal limits.
  • Goldmann lOPs noted in the high teens over the next several visits.

Final Diagnosis

  • Probable non-arteritic anterior ischemic optic neuropathy (NA-AION) in a patient with a small disc or “disc at risk” and systemic hypertension.
  • Arteritic anterior ischemic optic neuropathy (A-AION) is not supported in this case because no other common neurogical complaints were reported and test results were unremarkable for CRP and ESR.1
  • Papillitis followed by optic atrophy after a Swine Flu vaccination cannot be conclusively ruled out.2
  • Glaucoma suspect with strong consideration to lower lOPs.

Note

  • The disc became more elevated over the first 10 days and then subsided with diffuse optic nerve pallor within 1 month of initial vision loss.