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A 44-year-old woman with a 3-month history of bilateral, painless visual loss in the absence of other symptoms
Digital Journal of Ophthalmology 2012
Volume 18, Number 4
December 31, 2012
DOI: 10.5693/djo.03.2012.12.001
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Emily Shao, MBBS, BSC | Department of Ophthalmology, Chelsea and Westminster Hospital, London, UK
Kevin Gallagher, BMBCh | Department of Ophthalmology, Chelsea and Westminster Hospital, London, UK
Nabeel Malik, MBBS, FRCOPHTH | Department of Ophthalmology, Chelsea and Westminster Hospital, London, UK
Differential Diagnosis
The patient was noted to have a swollen optic disc in one eye and an atrophic optic disc in the other eye. Such a combination of signs is rare and may be caused by a variety of pathological processes.

Foster Kennedy syndrome (FKS) consists of a clinical triad of optic atrophy in one eye, papilledema in the contralateral eye, and anosmia, caused by space-occupying anterior fossa masses.(1) Associated symptoms of raised intracranial pressure, including nausea, vomiting, and headaches, and frontal lobe signs may be present, including emotional lability and memory loss.

In pseudo-FKS, optic disc pallor and contralateral disc swelling is present but is not caused by an intracranial mass. This may be caused by the same pathological process in each eye. For example, patients with bilateral sequential ischemic optic neuropathy or optic neuritis may have one pale, atrophic optic disc and a papillitis in the contralateral optic disc, mimicking the papilledema seen in FKS. Alternatively, two pathological processes may be responsible: any cause of unilateral optic disc pallor (eg, previous unilateral ischemic optic neuropathy or optic neuritis; unilateral optic nerve hypoplasia) in conjunction with raised intracranial pressure causing papilledema in the contralateral eye will give rise to this combination of signs.(2) Papilledema does not occur in optic atrophy because the loss of neural fibers in optic atrophy results in a lack of neurons to swell.