A Case of Posterior Ischemic Optic Neuropathy and Abducens Nerve Palsy

Tae Geun Song; Hye Young Park

doi:10.3341/jkos.2009.50.2.324

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Song and Park: A Case of Posterior Ischemic Optic Neuropathy and Abducens Nerve Palsy

Original Article

J Korean Ophthalmol Soc 2009;50(2):324-329.

Published online: 3 January 2009

DOI: https://doi.org/10.3341/jkos.2009.50.2.324

A Case of Posterior Ischemic Optic Neuropathy and Abducens Nerve Palsy

Tae Geun Song, MD, Hye Young Park, MD

Department of Ophthalmology, Kang Dong Sacred Heart Hospital, Seoul, Korea

Address reprint requests to Hye Young Park, MD Department of ophthalmology, Kang Dong Sacred Heart Hospital #445 Gil-dong, Gangdong-gu, Seoul 134-701, Korea Tel: 82-2-2224-2274, Fax: 82-2-470-2088, E-mail: hyiris@hanmail.net

Received 5 June 2008 Accepted 16 September 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of a patient with posterior ischemic optic neuropathy and abducens nerve palsy who responded to steroid therapy.

Case summary

A 47-year-old man visited our clinic with decreasing visual acuity and abduction limitation in his right eye, which suddenly started 4 days earlier. The best corrected visual acuity (BCVA) was 20/250 in the right eye and 20/20 in the left eye. Fundus examination showed normal in both eyes, and relative afferent pupillary defect was positive in the right eye. The visual field test showed a right central scotoma with inferior altitudinal field defect. In addition, the brain magnetic resonance imaging (MRI) was done. Orbit MRI, fluorescein angiography (FAG), and carotid ultrasonography results were normal. Therefore, the patient was diagnosed with non-arteritic posterior ischemic optic neuropathy. The systemic steroid therapy was started and tapered over a period of 5 weeks. At one month after treatment, the BCVA was 20/20 and abduction limitation in the right eye improved.

Keywords: Abducens nerve palsy, Posterior ischemic optic neuropathy, Steroid therapy

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Figure 1.

Nine cardinal gaze photographs. Patient shows limitation of abduction of the right eye in the right gaze position.

Figure 2.

Disc photographs show normal optic discs in both eyes.

Figure 3.

Fluorescein angiographs showing normal findings in the right eye.

Figure 4.

Initial Humphrey visual field test (central 30-2 threshold) shows central scotoma and inferior altitudinal defect in the right eye.

Figure 5.

The VEP shows a decrease in amplitude in the right eye.

Figure 6.

Orbit MRI (A) T1W1 image, (B) T1W1 with enhancement image. MRI shows no mass lesion, nor abnormal enhancement in the optic nerve.

Figure 7.

At one month after steroid therapy, the visual field test shows some inferior scotomas in the right eye.

Figure 8.

Nine cardinal gaze photographs after steroid therapy. The patient does not show limitation of abduction in the right eye.

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