Pseudotumor Cerebri - Papilledema

The images above are from a 20-year-old, obese female showing papilledema of the optic nerves (top photos) and enlarged blind spots (dark areas bottom photos) in both eyes. The patient complained of progressively worsening flashes of light followed by blurring for 3 weeks. Other symptoms included new onset of floaters and a blurred area in the superior temporal field of the left eye. She experienced intermittent episodes of vertical double vision and a mild headache. The initial exam showed visual acuity of 20/20 right eye and 20/25 left eye. The intraocular pressure was 18 right eye and 17 left eye, with normal reactive pupils and no afferent papillary defect. Confrontation fields and extraocular movement were normal. A slight exophoria was noted in the left eye. The fundus exam was normal with the exception of dilated vessels (green arrows) and blurred disc margins (papilledema) (yellow arrows) in both eyes. The patient was referred to neuro-ophthalmologist who confirmed the diagnosis of pseudotumor cerebri and started patient on a acetazolamide to decrease cerebrospinal fluid production, recommended weight loss and asked her to return in 3 months.