Case report

A 6 year old girl was referred urgently to our ophthalmology department with a one month history of headache and the finding of swollen optic discs in both eyes. The referring optometrist was concerned that the patient might have papilloedema.

The patient reported that her headache was intermittent, frontal, and associated with nausea. She denied vomiting or visual problems, including transient visual obscurations (sudden blanking of vision lasting seconds) and double vision. Apart from wearing glasses with a small hyperopic prescription, she had no previous ophthalmic or medical history of note. She was not taking any medication.

On examination, her pupils were dilated after pharmacological dilatation by the referring optometrist. Consistent with the expected effect of pupillary dilatation, the visual acuity with glasses was 6/9 in each eye. She had no visual field defect to confrontation, and colour vision was normal. Ocular movements were full, and the rest of the cranial nerve examination was unremarkable. Funduscopy showed swollen optic discs in both eyes, with anomalous branching of the retinal vasculature (fig 1⇓). We started investigations to determine whether optic disc drusen were present. …