Compressive Optic Atrophy

The images above are the optic nerves and visual fields from a 42 year old female. She presented with complaints of decreasing vision for two years in the left eye and possible tumor behind the left eye. The vision in right eye was 20/20 and the left was HM. The intraocular pressures were 10 in the right eye and 12 in the left eye. There was of an afferent pupillary defect in left eye. Confrontation fields were performed which revealed constriction nasally, superiorly and temporally. The slit lamp exam was normal. The fundus exam was normal in the right eye, but the left showed a pale optic nerve (note the difference between the top images). A 24-2 visual field was performed which showed visual field loss in the left eye; the right is normal. The exam findings are consistent with a sphenenoid ridge mengioma causing compression of and damage to the optic nerve which was confirmed on MRI scanning of the orbits and brain. The prognosis for return of vision for this patient is poor