Unveiling Inflamatory Optic Neuropathy with Silicone Oil Endotamponade: A Clinical Case

CASE PRESENTATION

A 59-year-old patient had a history of retinal detachment in the right eye, undergoing surgical retinopexy and silicone oil use, with progressive worsening of vision in that eye, despite multiple oil exchanges and cataract surgery aimed at improving vision, but without success. About 4 months before evaluation, she developed progressive, painless worsening of vision in the contralateral eye. Referral to Neuro-ophtalmologist revealed finger counting visual acuity in the left eye at 50 centimeters, right optic nerve atrophy and the left optic nerve hyperemia. OCT showed no changes in RNFL thickness, and MRI showed T2 hyperintensity throughout the right optic nerve, chiasm, and optic tracts, with no contrast enhancement. She was then hospitalized for further investigation. Workup showed normal CSF, negative AQP4-IGG, absent oligoclonal bands, and spinal cord MRI without demyelinating plaques. Considering a possible atypical optic neuritis in the patient's single eye, pulse therapy with methylprednisolone for 5 days and gradual oral prednisone tapering were initiated, resulting in partial improvement of visual acuity (now finger counting at 1.5m), reduction of central scotoma, and even slight improvement in the right eye.

DISCUSSION

Limited reports in the literature have documented the diffusion of silicone oil into the CNS, with only one reported case of optic neuritis in the contralateral eye. We speculate whether this condition resulted from direct toxic and inflammatory effects of silicone oil or triggered autoimmune activity targeting the optic pathways. The partial response to corticosteroid, initiated 4 months after the onset of symptoms and in the absence of gadolinium enhancement, could support the presence of a sustained local inflammatory component.

FINAL COMMENTS

This case report underscores significant concerns regarding the neurological risks associated with silicone oil endotamponade in retinal surgeries. It also reinforces existing literature highlighting potential adverse and treatable effects on the CNS following such procedures.