To report clinical features, evaluation, management and clinical outcomes in a series of 5 patients with uveitis and bilateral optic disc edema (ODE) with secondary intracranial hypertension (IHT).
Retrospective interventional case series. 5 patients with uveitis and bilateral ODE underwent a complete eye examination including BCVA, color vision, slit lamp exam, fundoscopy and systemic work-up for etiology of uveitis. Fundus photo, FFA, SD-OCT, B scan, visual fields tests, MRI, MRV, lumbar puncture for CSF opening pressure (OP) and CSF analysis were performed.
All 5 patients were young (15 to 33 years). 3 patients had panuveitis, 2 had retinal vasculitis. MRI and MRV showed stenosis or hypoplasia of dural sinuses and thickened optic nerves in 4 out of 5 patients. CSF OP was raised in 4 out of 5 patients (25-33 cm H2O), while CSF analysis was normal in all patients. B scan showed increased subarachnoid fluid around optic nerve in all patients. FFA in 4 out of 5 patients showed disc leak without any perivascular leak. Patients were treated with oral diuretics, steroids and IMT which led to resolution of ODE in 8-10 months of treatment.
ODE in uveitis can be of varied etiology including active inflammation, systemic medications or systemic associations. Diagnosis of secondary IHT is a challenge since the signs and symptoms can be very subtle. Only 1 out of 5 patients in this series had complaints of headache. Hence, one must have a high index of suspicion while evaluating uveitis patients with bilateral ODE to rule out IHT as an underlying cause. Early diagnosis and treatment would reduce the risk of vision loss and prevent morbidity in such patients.