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Case: Meningioma masquerades as glaucoma
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CHICAGO – A patient’s progressive changes on visual field testing, despite glaucomatous disease management and diagnostic testing pointing to glaucoma, led one clinician to look beyond glaucoma for another cause of the signs and symptoms.
“In many ways this was a patient who looked like she had glaucoma,” Barbara A. Smit, MD, PhD, said at Glaucoma Day preceding the American Society of Cataract and Refractive Surgery meeting. “She had pressures up around 26 mm Hg at one point in time, she had thin corneas, she had notching of her optic nerve and cupping… She had had progressive change on her visual field testing despite the fact that her pressures had been successfully lowered on her exams.”
To reconcile the diagnosis with the continued visual field loss, Dr. Smit followed up with computed tomography scanning, which showed a meningioma wrapped around the optic nerve, causing tenting of the optic nerve and clearly causing her visual field loss, Dr. Smit said.
“Despite everything looking to me like glaucoma, the fact that all the pieces just didn’t hang together quite right finally led us to do this imaging,” she said.
“This is a case to keep in mind,” she said, “when things aren’t going well and you don’t know why.”
- Disclosure: Dr. Smit has financial interest in Glaukos Corporation.