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case_images: Findings from the first ophthalmological examination at Olympia Eye Hospital. a Optical coherence tomography shows that the temporal side of the left optic nerve was slightly atrophic, whereas the right optic nerve is normal. b In both eyes, central scotoma is observed using Goldmann perimetry.
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case_images: Kinetic Goldmann perimetry revealed a central scotoma in both eyes (OU) (Fig. 1a). Optical coherence tomography indicated slight atrophy of the left optic nerve's temporal side of circumpapillary retinal nerve fiber layer thickness, while the right appeared normal (Fig. 1b). The circumpapillary retinal nerve fiber layer thickness was thinner compared to the initial examination (Fig. 1b) even in OS.
case_images: MRI at Olympia Eye Hospital. a T1-weighted coronal imaging shows enlargement of the four external eye muscles in both eyes with compression of the optic nerve. b Fat suppression in T2-weighted coronal image: high signal intensity of the optic nerves is not clear. c T1-weighted axial imaging shows compression of the optic nerve bilaterally caused by enlargement of all four rectus muscles.
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case_images: Magnetic resonance imaging (MRI) of the brain and orbits demonstrated bilateral enlargement of all four rectus muscles, sparing their tendinous insertions, and compressing the optic nerve in coronal (Fig. 2a, b) and axial (Fig. 2c) sections.
case_images: MRI after therapeutic intervention at Olympia Eye Hospital. After steroid semi-pulse therapy and left orbital decompression surgery, the compressed optic nerves were relieved bilaterally by reducing the size of the enlarged muscles.
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case_images: OD and 0.1 (Snellen equivalent 20/200) in OS. Over the next 2 months, as her oral steroid dose was tapered, she underwent left orbital decompression surgery, which alleviated optic nerve compression by reducing the size of the enlarged muscles (Fig. 3).
case_images: Findings of Goldmann perimetry and optical coherence tomography after therapeutic intervention. a Central scotoma in the right eye decreased, with no change in the left eye. b Bilateral optic nerve atrophy is observed in both eyes.
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case_images: Despite this intervention, her BCVA in OS stagnated at 0.1, with persistent central scotomas in OU (Fig. 4a). At that point, the optic nerves were already atrophic in OU (Fig. 4b).
case_images: MRI at The Jikei University Katsushika Medical Center. Coronal fat-suppressed STIR imaging of the orbit reveals the swollen left optic nerve with high signal intensity.
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case_images: However, STIR MRI of the orbit indicated swelling and high signal intensity in the left optic nerve, suggestive of optic neuritis (Fig. 5).