Optic disc edema in association with sudden onset panuveitis is a rare clinical entity. This entity was first reported by Monheit and Read in 2005 as optic disc edema associated with anterior uveitis and no posterior uveitis. To our knowledge, the clinical features and course of optic disc edema associated with sudden onset panuveitis have not been reported.
A 35-year old African American female presented with bilateral red eyes for three days. Systemic history was remarkable for fibromyalgia, asthma and anemia. She reported taking Proventil inhaler for her asthma. Best corrected visual acuity was 20/30 OD, OS. Pupils were normal without afferent defect. Slit lamp examination revealed bilateral nodular episcleritis. Anterior chambers were quiet. Dilated fundus examination revealed bilateral optic disc edema. B-scan ultrasonography was negative for posterior scleritis. Spectral domain OCT demonstrated increased retinal nerve fiber thickness and positive angle of deflection of the RPE-Bruch’s complex suggestive of papilledema. MRI/MRV of brain and orbits with and without contrast were ordered and returned unremarkable. Five days later, the patient presented with panuveitis in the left eye. Serology to rule-out toxoplasmosis, sarcoidosis, syphilis, lupus and rheumatoid arthritis was negative. Eighty milligrams oral steroids were initiated and tapered over three weeks. Resolution of the panuveitis occurred within three weeks and the vision returned to 20/20 in each eye, while optic disc edema lagged by one month. The positive deflection of the RPE-Bruch’s complex ultimately returned to a neutral position, suggesting normalization of intracranial pressure.
To our knowledge, this is the first report of the clinical features and course of optic disc edema associated with sudden onset panuveitis. Resolution of the disc edema lagged that of the uveitis. In the presence of normal pupil function, return of normal vision, and absence of infectious etiology, this case suggests that treatment may be directed towards the uveitis rather than prolonging treatment until optic disc edema resolves.