J Korean Ophthalmol Soc.  2017 May;58(5):620-625. 10.3341/jkos.2017.58.5.620.

Bilateral Optic Disc Edema Associated with Hypocalcemia

• Heo DW
• Kim JY
• Lee YH

• KMID: 2378637
• DOI: http://doi.org/10.3341/jkos.2017.58.5.620

Abstract

PURPOSE
To report a case of bilateral optic disc edema associated with hypocalcemia.
CASE SUMMARY
A 48-year-old woman visited our ophthalmology department with decreased vision and disturbance of the visual field in the right eye, which began 2 days prior to presentation. The patient history indicated she had undergone total thyroidectomy 3 months prior and was given an oral calcium preparation. She had no eye pain, headache, tinnitus or diplopia. Her best corrected visual acuity of both eyes was 1.0, and color vision was normal in both eyes although a mild relative afferent pupillary defect was present in the right eye. Severe bilateral optic disc edema was present in the right eye. A Humphrey visual field test revealed an enlarged blind spot and peripheral nasal step scotoma in the right eye. The Cerebrospinal fluid (CSF) opening pressure was within the normal range and there were no abnormal findings regarding CSF. Additionally, there were no remarkable findings on brain magnetic resonance imaging nor neurologic tests. Her serum calcium was 5.9 mg/dL (normal range: total calcium 8.7-10.6 mg/dL), and an intravenous calcium supplement was started. Visual disturbance and optic disc edema improved 2 days after replacement and the optic disc edema completely dissolved 2 months later.
CONCLUSIONS
Hypocalcemia may cause bilateral optic disc edema and can be recovered through adequate calcium supplementation, and it is necessary to prevent and promptly detect this rare complication.

Keyword

Disc swelling; Hypocalcemia; Optic neuropathy; Papilledema

MeSH Terms

Brain
Calcium
Cerebrospinal Fluid
Color Vision
Diplopia
Edema*
Eye Pain
Female
Headache
Humans
Hypocalcemia*
Magnetic Resonance Imaging
Middle Aged
Ophthalmology
Optic Disk
Optic Nerve Diseases
Papilledema
Pupil Disorders
Reference Values
Scotoma
Thyroidectomy
Tinnitus
Visual Acuity
Visual Field Tests
Visual Fields
Calcium

Figure

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  Figure 1 Humphrey visual field on the initial examination. The Blind spot was enlarged and a scotoma was noticeable in the nasal visual field of the right eye.

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  Figure 2 Fundus photographs on the initial examination. There were optic disc swellings in both eyes. Optic disc swelling was asymmetric and more severe in the right eye. The right retinal vein was tortuous.

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  Figure 3 Fundus photographs on the follow-up examination two months later. Optic disc swellings were resolved in both eyes. There was peripapillary high water mark and mild disc pallor in the right eye.

• 

  Figure 4 Humphrey visual field on the visit two months later. The Blind spot and the scotoma on the nasal field of the right eye decreased.

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