Abstract

P 067

Papilledema in Crohn’s disease

Egetenmeier H., Lang G. E.
Department of Ophthalmology, University of Ulm

Objective: Ocular manifestations in Crohn’s disease are infrequent. The most common manifestation is an uveitis. In up to 30% an alteration of the nervous system occurs. In rare cases an optic nerve edema has been reported.
Methods: A 40-year-old woman presented in September 2006 with an iridocyclitis in her right eye. The visual acuity was 1.0. There were no chronic diseases or symptoms in the medical history. After topical therapy with steroidal and non-steroidal anti-inflammatory eyedrops the iridocyclitis improved. 12 days after first presentation an optic disc swelling with peripapillary intraretinal hemorrhages occurred, while there was a mild inflammation of the eye. Functionally, visual field defects (constriction of the visual field, enlarged blind spot) were found, visual acuity had decreased to 0.6.
Results: Neurological examination revealed no underlying disease. The blood analysis showed an increased C-reactive protein. The patient reported an acute “bowel infection”. A coloscopy was performed and Crohn’s disease was diagnosed and confirmed by histological examination. Under systemic steroid therapy the optic nerve edema improved. Fluorescein angiography showed a hyperfluorescence of the optic nerve head. After three months, the papilledema was healed and the visual field was normal again.
Conclusions: The differential diagnosis of an optic nerve edema comprehends an inflammation like a bowel disease (Crohn’s disease). By an adequate treatment complete convalescence can be achieved.

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