Milad Modabber, MD, MSc | Department of Ophthalmology, McGill University, Montreal, Quebec, Canada Vasudha Gupta MD, FRCSC | Department of Ophthalmology, Queen’s University, Kingston, Ontario, Canada Amadeo R. Rodriguez, MD | Department of Surgery Ophthalmology and Medicine Neurology, McMaster University, Hamilton, Ontario, Canada
On initial examination, the patient’s best-corrected visual acuity was 20/100 in the right eye and 20/70 in the left eye. The pupils were symmetrically 3 mm in diameter and poorly responsive to light in both eyes, with no evidence of a relative afferent pupillary defect. Intraocular pressure was recorded as 16 mm Hg in each eye. Slit-lamp biomicroscopy was unremarkable. Dilated fundus examination revealed marked optic nerve head swelling suggestive of papilledema and tortuous and dilated retinal venules (Figure 1A).