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Quiz: One Pale Disc, One Swollen Disc

Test your understanding of this case with 10 questions.

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Case Information
Review the case details while answering questions

PATIENT DEMOGRAPHICS

41-year-old female

PRESENTING COMPLAINT

Visual disturbance with poor vision in one eye and preserved vision in the other. Patient reports difficulty with peripheral vision and occasional headaches.

EXAMINATION FINDINGS

Visual Acuity: OD: 6/60, OS: 6/9

Pupils: Assessment pending - detailed pupil examination required

Fundus: OD: Pale optic disc consistent with optic atrophy. OS: Swollen optic disc with blurred margins consistent with papilloedema

INVESTIGATIONS

Right eye fundus: optic atrophy with pale disc appearance

Right eye fundus: optic atrophy with pale disc appearance

Left eye fundus: papilloedema with disc swelling and blurred margins

Left eye fundus: papilloedema with disc swelling and blurred margins

Fundus Photography: Right eye shows optic atrophy with pale disc appearance. Left eye demonstrates papilloedema with disc swelling and blurred margins. This combination suggests Foster Kennedy pattern - optic atrophy in one eye with papilloedema in the fellow eye.

OCT: asymmetric RNFL - right eye thinning (atrophy), left eye thickening (swelling)

OCT: asymmetric RNFL - right eye thinning (atrophy), left eye thickening (swelling)

OCT Optic Disc Analysis: OCT demonstrates asymmetric retinal nerve fiber layer changes: right eye shows significant RNFL thinning consistent with optic atrophy, while left eye shows RNFL thickening consistent with papilloedema. This confirms the clinical findings and supports the diagnosis of Foster Kennedy pattern.

Visual Field Assessment: Right eye: Superior altitudinal defect consistent with optic nerve damage. Left eye: Enlarged blind spot secondary to papilloedema with otherwise preserved peripheral fields.

Neuroimaging (MRI Brain and Orbits): Pending urgent imaging to exclude intracranial space-occupying lesion compressing optic pathways and causing raised intracranial pressure.

Question 1 of 10

This patient has headaches, peripheral vision difficulty, optic atrophy in one eye, and papilloedema in the other. Which explanation best accounts for this asymmetric disc appearance?

Question 2 of 10

On OCT, what would you expect in an eye with established optic atrophy?

Question 3 of 10

The right eye shows a cup-to-disc ratio of 0.73 on OCT. Why might this be misleading if interpreted in isolation?

Question 4 of 10

Foster Kennedy syndrome classically results from a mass in which anatomical location?

Question 5 of 10

Based on the clinical and OCT findings so far (MRI still pending), what is the most likely working diagnosis?

Question 6 of 10

What is the cause of pseudo-Foster Kennedy syndrome?

Question 7 of 10

If the left eye's central vision is preserved but the blind spot is enlarged, what could be the cause?

Question 8 of 10

Which new finding would suggest this has progressed beyond a purely ophthalmological problem and needs urgent neurosurgical input?

Question 9 of 10

The following is an appropriate management step: Urgent neuroimaging (MRI brain and orbits) to exclude an intracranial space-occupying lesion.

Question 10 of 10

This patient's atrophic right eye shows a superior altitudinal visual field defect. Why is this finding worth specific attention, even before MRI results are available?