Abstract

P 188

Unilateral papilledema in Crohn’s disease

Susanne C. Goebels, Arnulf Schnaidt, Karin A. Brückner, Kouris Ninios, Ursula Löw, Berthold Seitz
Klinik für Augenheilkunde, Universitätskliniken des Saarlandes, Homburg/Saar

Objective
Crohn´s Disease is a chronic granulomatous colitis with the typical findings of patchy areas of inflammation (“skip lesions”). It can be associated with an anterior uveitis. A papillitis is a rare ocular manifestation of Crohn´s Disease.
Methods
A 44-year-old male patient with known Crohn´s Disease presented himself to our department with a loss of visual acuity in his left eye and strong retroorbital pain. The visual acuity in the right eye was uncorrected 1.0, in the left eye 0.1. We found a relative afferent pupillary deficit in the left eye, strong retroorbital pain in primary postion and during eye movements. The slit lamp biomicroscopy showed an anterior segment without irritations and clear media. The fundoscopy demonstrated a vital papilla and a normal vascular status in the right eye. In the left eye a severe papilledema was present.
Results
A cranial expanding lesion could be excluded by performing a cranial CT and MRT, an inflamatory cause was rule out by serology and lumbar puncture. Applying corticosteriods (methylprednisolone 1000 mg/d for 5 days) we found an improvement of the findings. After ten days, the visual acuity stabilised at 0.5 and the papilledema decreased markedly.
Conclusions
A papilledema is a rare complication of patients suffering from Crohn´s Disease. The cause of the papilledema may be explained by a focal vasculitis or an allergic hypercoagulopathy. High dose systemic therapy with corticosteroids has the potential to improve the prominence of the optic nerve head and the visual acuity.

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