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Acute Idiopathic Blind Spot Enlargement: A Big Blind Spot Syndrome Without Optic Disc Edema

Acute Idiopathic Blind Spot Enlargement: A Big Blind Spot Syndrome Without Optic Disc Edema Abstract • We examined seven patients who had a syndrome of symptomatic monocular blind spot enlargement without optic disc edema. Two patients had previous blind spot enlargement that resolved over several months. The scotoma in each patient was absolute, measured 15° to 20° in diameter, had steep geographic margins, and extended to within 5° to 10° of fixation. Typically, patients had normal visual acuity, color vision, pupillary responses, and ophthalmoscopic findings. Photostress recovery, tested in two patients, was prolonged in the affected eye. Fluorescein angiography showed no abnormalities corresponding to the scotoma. Orbital computed tomographic scans in three patients and visual evoked responses in one patient were normal. Multifocal electroretinography, performed in two patients, showed loss of retinal waveforms in a large region surrounding the optic disc. Our findings suggest that retinal dysfunction produces this big blind spot syndrome, but we do not know its cause. References 1. Traquair HM: An Introduction to Clinical Perimetry . St Louis, CV Mosby Co, 1949. 2. Glaser JS, Savino PJ, Sumers KD, et al: The photostress recovery test in the clinical assessment of visual function . Am J Ophthalmol 1977;83:255-260. 3. Miller NR: The big blind spot syndrome: Unilateral optic disc edema without visual loss or increased intracranial pressure , in Smith JL (ed): Neuro-ophthalmology Update . New York, Masson Publishers USA Inc, 1977, pp 163-169. 4. Brégeat P: L'Oèdeme Papillaire . New York, Masson Publishers USA Inc, 1956. 5. Chamlin M, Davidoff L: Papilledema . Arch Neurol 1952;68:213-232. 6. De Schweinitz GE: The relation of cerebral decompression to the relief of the ocular manifestations of increased intracranial tension . Ann Ophthalmol 1911;20:271-284. 7. Schlaegel TF Jr, Kenny D: Changes around the optic nervehead in presumed ocular histoplasmosis . Am J Ophthalmol 1966;62:454-458. 8. Kranenberg EW: Craterlike holes in the optic disc and central serous retinopathy . Arch Ophthalmol 1960;64:912-924.Crossref 9. Hayreh SS, Cullen JF: Atypical minimal peripapillary choroidal colobomata . Br J Ophthalmol 1972;56:86-96.Crossref 10. Klien BA: Macular and extramacular serous chorioretinopathy . Am J Ophthalmol 1961;51:231-242. 11. Straatsma BR, Allen RA, Pettit TH: Central serous retinopathy . Trans Pac Coast Otoophthalmol Soc 1966;47:107-127. 12. Gass JDM: Pathogenesis of disciform detachment of the neuroepithelium: II. Idiopathic central serous choroidopathy . Am J Ophthalmol 1967;63;587-615. 13. Sutter EE, Dodsworth-Feldman B, Haegerstrom-Portnoy G: Simultaneous multifocal ERGs in diseased retinas . Invest Ophthalmol Vis Sci 1986;27( (suppl) ):301. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Acute Idiopathic Blind Spot Enlargement: A Big Blind Spot Syndrome Without Optic Disc Edema

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Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1988.01060130050026
Publisher site
See Article on Publisher Site

Abstract

Abstract • We examined seven patients who had a syndrome of symptomatic monocular blind spot enlargement without optic disc edema. Two patients had previous blind spot enlargement that resolved over several months. The scotoma in each patient was absolute, measured 15° to 20° in diameter, had steep geographic margins, and extended to within 5° to 10° of fixation. Typically, patients had normal visual acuity, color vision, pupillary responses, and ophthalmoscopic findings. Photostress recovery, tested in two patients, was prolonged in the affected eye. Fluorescein angiography showed no abnormalities corresponding to the scotoma. Orbital computed tomographic scans in three patients and visual evoked responses in one patient were normal. Multifocal electroretinography, performed in two patients, showed loss of retinal waveforms in a large region surrounding the optic disc. Our findings suggest that retinal dysfunction produces this big blind spot syndrome, but we do not know its cause. References 1. Traquair HM: An Introduction to Clinical Perimetry . St Louis, CV Mosby Co, 1949. 2. Glaser JS, Savino PJ, Sumers KD, et al: The photostress recovery test in the clinical assessment of visual function . Am J Ophthalmol 1977;83:255-260. 3. Miller NR: The big blind spot syndrome: Unilateral optic disc edema without visual loss or increased intracranial pressure , in Smith JL (ed): Neuro-ophthalmology Update . New York, Masson Publishers USA Inc, 1977, pp 163-169. 4. Brégeat P: L'Oèdeme Papillaire . New York, Masson Publishers USA Inc, 1956. 5. Chamlin M, Davidoff L: Papilledema . Arch Neurol 1952;68:213-232. 6. De Schweinitz GE: The relation of cerebral decompression to the relief of the ocular manifestations of increased intracranial tension . Ann Ophthalmol 1911;20:271-284. 7. Schlaegel TF Jr, Kenny D: Changes around the optic nervehead in presumed ocular histoplasmosis . Am J Ophthalmol 1966;62:454-458. 8. Kranenberg EW: Craterlike holes in the optic disc and central serous retinopathy . Arch Ophthalmol 1960;64:912-924.Crossref 9. Hayreh SS, Cullen JF: Atypical minimal peripapillary choroidal colobomata . Br J Ophthalmol 1972;56:86-96.Crossref 10. Klien BA: Macular and extramacular serous chorioretinopathy . Am J Ophthalmol 1961;51:231-242. 11. Straatsma BR, Allen RA, Pettit TH: Central serous retinopathy . Trans Pac Coast Otoophthalmol Soc 1966;47:107-127. 12. Gass JDM: Pathogenesis of disciform detachment of the neuroepithelium: II. Idiopathic central serous choroidopathy . Am J Ophthalmol 1967;63;587-615. 13. Sutter EE, Dodsworth-Feldman B, Haegerstrom-Portnoy G: Simultaneous multifocal ERGs in diseased retinas . Invest Ophthalmol Vis Sci 1986;27( (suppl) ):301.

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Jan 1, 1988

References