Progressive Decline in Visual Acuity Due to Optic Nerve Sheath Meningioma

A 58-year-old male patient presented to an ophthalmologist due to a 3- to 4-year history of progressive deterioration in visual acuity in the left eye. Distance visual acuity was CC 0.4  P on the left and CC 1.0 on the right. Intraocular pressure was 19  mm Hg on both sides. In addition to bilateral cataract, ptosis and eyelid edema were noticeable on the left side. In the ocular fundus, the margin of the left optic disc was blurred and raised. The right optic disc was normal and the macula intact on both sides. To exclude retrobulbar affection of the left optic nerve, an MRI of the orbit was performed, revealing a retrobulbar and contrast-enhancing mass (arrows) growing in a circular manner around the left optic sheath, as well as slight exophthalmos on the left side. These findings were typical for primary optic nerve sheath meningioma, which accounts for 5–10% of all intraorbital masses. Since neurosurgical resection was contraindicated, photon-based fractionated (54 Gy) stereotactic radiotherapy was performed. At follow-up 3 months after radiotherapy, clinical as well as imaging findings were stable.

Figure

Dr. med. Dirk Daubner, Institut und Poliklinik für diagnostische und interventionelle Neuroradiologie, Universitätsklinikum Carl Gustav Carus, Dresden, [e-mail];

Dr. med. Sören Waibel, Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Carl Gustav Carus, Dresden

Lucas Piwarz, Medizinische Fakultät der Friedrich-Schiller-Universität Jena

Conflict of interest statement: The authors state that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Daubner D, Waibel S, Piwarz L: Progressive decline in visual acuity due to optic nerve sheath meningioma. Dtsch Arztebl Int 2022; 119: 620. DOI: 10.3238/arztebl.m2022.0066