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A 16-year-old girl with bilateral optic disc swelling
Digital Journal of Ophthalmology 2011
Volume 17, Number 1
March 12, 2011
DOI: 10.5693/djo.03.2011.02.003
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Usman Mahmood, MB BS, MRCS Ed | Wolverhampton and Midland Counties Eye Infirmary
Syed M Asad Ali, MB BS, MRCS Ed | New Cross Hospital
Mohammad Samir Dowlut, MB ChB | New Cross Hospital
Bala Manoj, FRCS, MRCOphth, MS, DO | New Cross Hospital
Diagnosis and Discussion
On presentation, the patient had had headaches for 6 months, bilateral disc swelling with enlarged blind spots, and was moderately hypertensive. She did not have any other signs of hypertensive retinopathy or of raised intracranial pressure. CT scan of the head and orbits was normal. Abdominal imaging showed a large ovarian cyst, but no hydronephrosis. She was diagnosed with hypertensive optic neuropathy.

This case is unusual because the intra-abdominal cyst seems to have caused hypertension and bilateral disc swelling in the absence of common funduscopic signs of hypertensive retinopathy. Whereas polycystic ovarian syndrome is known to cause hypertension through hemodynamic alterations and variations in peripheral vascular resistance, it is uncommon for bilateral disc swelling to be a presenting feature.(5,6) Moreover, the presence of a large solitary ovarian cyst does not fulfill the criteria of PCOS diagnosis.(7) We hypothesize that the size of the ovarian cyst may have had a role in compressing the renal veins, thus causing an associated hypertension and bilateral optic neuropathy.

Bilateral optic disc swelling secondary to malignant hypertension has been reported in children, although this is usually accompanied by, for example, retinal hemorrhages, exudates, or cotton wool spots.(8)