DR. RANJINI H

DR NEENA R, Dr. MARIAN PAULY

Abstract

74 year old male presented with sudden drop of vision in left eye(LE) since 5 days.He had RAPD and vision of CF1m in LE.Fundus showed hyperemic disc in LE and small disc in right eye.Ocular movements were full.He had high blood sugar.Considering it to beAION,he was referred to physician and MRI brain was advised However,patient was lost for follow up and came back 1.5 months later with vision of PL in LE.He had developed proptosis,ptosis and painless limitation of all EOM with persistent RAPD s/o Orbital Apex Syndrome which was confirmed by MRI.Fundus showed a combined CRAO and CRVO.He was given IVMP for 3days.Raised IgG4 was noted in blood work up.An incisional biopsy through orbit was done and it was confirmatory of IgG4disease.Patient is presently on immunomodulators.On 1yr follow up,vision is unchanged but there is significant improvement in ptosis,proptosis and ocular movements.IgG4RD presenting as optic neuropathy is rare and can be an early manifestation of orbital involvement