OPTIC NERVE SWELLING

[mybrowneyes]

I have had chicken pox at the age of 12.  Later on in 1996, I developed a rare infection on my right retina which was successfully treated with meds.  In 1999, the attack appeared on the left retina but just worse as my vision was affected.  Again treatment restored vision and all was normal.

Soon after in 2000, I contracted genital herpes type 2. Recently, in December 2007 I noticed over a 3-4 day period, blurriness and vision obstruction and I went for an eye exam which revealed optic nerve swelling in both eyes, more so in the left.  MRI showed no brain tumor, and a lumbar puncture said my Cerebrospinal fluid (CSF) reading of the brain was 15cm and brought to 7cm.  The neurosurgeon says I have Pappiladema.  The normal range they tell me is 10 but after reading, the literature says 10-20 is acceptable.

After researching, I see that herpes zoster from the chicken pox virus can give rise to both optic nerve and retina swelling and on the other hand, herpes simplex can cause eye herpetic keratitis which is more cornea related, not optic or retina related.  I am not sure if all 3 eye organs can be linked and affected and interpreted independently based on herpes zoster and herpes simplex.

I started on steroidal dexamethasone 2mg daily for 7 days and now replaced with Corodex 1mg twice a day for a total of 3 weeks and Apo Acetazolamide 250mg with 1 twice a day since lumbar puncture.

My question is can you identify whether my eye problems are as a result of herpes zoster, herpes simplex or pappiledema?  And exactly what treatment would you recommend for me?  Am I on the way to recovery?

Thanks and regards,
Eagerly awaiting your reply.

[Michael J Kutryb, MD]

First off genital herpes probably has absolutely nothing to do with this.  Second, it sounds like you are being treated for pseudotumor cerebri which often has no identifiable cause.  I could speculate that somehow herpes zoster is involved here someway but could never prove that.  I don't know what retinal condition you had in past and how it was treated so well. What did you have and what was treatment.  I think right now you need to talk to your doctor and see if you are being treated for pseudotumor cerebri.  If so you need to concentrate your research on that subject because it is Definitely the main issue for you now.

MJK MD

[mybrowneyes]

Hi Dr. Kutryb,

Sorry for not responding soon but I had several doctors visits to get the info you have asked.  I was diagnosed with acute multifocal plaquoid pigmentary epitheliopathy  in 1996 in the right eye, then 1n 1999 in the left eye.  I was treated on both occasions with Pregnisolone for about 7-10 days and vison restored completely.  

My last slit lamp test showed some changes though, good being that the optic nerves have started going down and my vision is better.  However, the optholmologists saw some inflammatory changes and retinal vein segmentation.  My white blood cells are 19 but the nurosurgeon says he thinks that is a side effect of the Crodox steroids that I only complete last night.  I still am on Apo-Acetazolamide for the next 9 days 250 mg - 1 tablet twice a day which started on 1/1/08.  Steroids started on 1/1/08 included Dexamethazone  1mg - 2 tabs 3x daily for 7 days and then replaced with Corodex 1mg 2 tabs 2xdaily for 14 days - a total of 21 days.  

On looking back in the last year Dr. I have had chronic allergic reactions to things i would normal eat and detergents at home so much so that one nugh I almost died after taking a alkaselza for my stomach not realising I am allergic to aspirin.  My eyes in the last 6 months have been extremely sensitive and wold get red and swell out of the blu, I would scratch, rub, wash with water and many times have to soothe with ice at night.  could this all be allergy realted?

I am booked to see the endocronologist on Febriary 9 for his consultation as we want to look at that study regime but I need the steroids to wear off first to be able to draw good blood.  I already did a thyroid ultrasound which is perfectly normal and lots of people tell me that if I had Cushing's disease, I would have lots more symptoms.

Well Dr. I thank you for your advice and look out for your informative medical expertise once again.

Take care.

Stacey