Bilateral choroidal folds and optic neuropathy: a variant of the crowded disk syndrome?
OBJECTIVE
To describe the clinical features of the syndrome that includes bilateral choroidal folds and optic neuropathy and to propose a novel etiology to explain this presentation.


METHODS
Observational small case series.


METHODS
Three patients.


METHODS
Three patients received an extensive clinical work-up including complete ocular examination, A and B scan ultrasonography, Humphrey visual field analysis, and imaging of the brain and orbit. Neurological consultation was obtained in each patient two of whom underwent lumbar puncture. The findings of this detailed investigation are reported.


RESULTS
Each patient demonstrated bilateral choroidal folds with optic disk congestion and leakage in one eye and optic atrophy in the fellow eye. Extensive ocular and extraocular investigation failed to uncover a specific etiology. Pseudotumor cerebri, a well-documented cause of papilledema and choroidal folds, was ruled out in each case. Each patient did demonstrate variable degrees of hyperopia and shortened axial lengths.


CONCLUSIONS
The syndrome of bilateral choroidal folds and optic neuropathy may have various etiologies. Pseudotumor cerebri needs to be definitively ruled out. Normal neuro-ophthalmological investigation including lumbar puncture may indicate an alternative cause. Idiopathic acquired hyperopia in middle-aged patients who are hyperopic with shortened axial lengths may be associated with choroidal folds and a constricted scleral canal causing optic disk congestion and complicated by nonarteritic anterior ischemic optic neuropathy due to a crowded disk.
Jules Stein Eye Institute, Dept of Ophthalmology, UCLA School of Medicine, Los Angeles, California 90095, USA. dsarraf@ucla.edu
David
D
Sarraf
Steven D
SD
Schwartz
D000368:Aged; D015862:Choroid Diseases / Q000209:etiology*; D005451:Fluorescein Angiography; D006801:Humans; D006956:Hyperopia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D009898:Optic Disk / Q000473:pathology*; D018917:Optic Neuropathy, Ischemic / Q000209:etiology*; D013577:Syndrome; D014792:Visual Acuity; D014794:Visual Fields