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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
Examination
Corrected visual acuity was 6/4 in both eyes. No color vision deficit could be elicited. Anterior segments were unremarkable in both eyes. Pupillary reactions were normal, with no relative afferent defect. Dilated fundus examination showed bilateral optic disc swelling (Figure 1) with absent spontaneous venous pulsations, although the retinal vasculature appeared normal. Goldmann visual fields (Figure 2) showed an enlarged blind spot in both eyes. B-scan ultrasonography showed no evidence of optic nerve head drusen. Computed tomography (CT) of the head and orbits was normal, and lumbar puncture revealed a cerebrospinal fluid opening pressure of 13 cm H2O (normal pediatric range, 11.5-28 cm H2O).(1)

General physical examination was normal, apart from a distended abdomen. At 76 kg, the patient was slightly overweight for her height (5'4") and her blood pressure was elevated, at 150/106 mm Hg. A pediatric referral was arranged. Ambulatory blood pressure monitoring by the pediatricians showed an average blood pressure of 156/110. A hypertensive work-up ensued.
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Figure 1
Fundus photographs of right (A) and left (B) eyes at presentation.

Figure 2
Results of Goldmann visual field testing of right (A) and left (B) eyes at presentation.