Background: Optic nerve glioma in the elderly is rare and has a poor prognosis.
Case: An 81-year-old woman presented with visual disturbance in the left eye. Her visual acuity was 0.9 in the right eye and 0.2 in the left eye. The left eye showed optic disc swelling, and enlargement of optic nerve was indicated by orbital magnetic resonance imaging (MRI) with gadolinium enhancement, suggesting optic neuritis. Visual acuity of the left eye temporarily improved with steroid pulse therapy, but then deteriorated to no light perception. The left optic nerve head showed progressive atrophic changes, with enlargement of the optic nerve spreading to the optic chiasm, resulting in visual disturbance and visual field defect in the right eye. Intracranial biopsy of the optic nerve showed malignant optic nerve glioma (grade 4). Bilateral blindness developed 1 year 10 months after the initial visit, and the patient died 11 months after that.
Conclusions: Although it is rare, malignant glioma of the optic pathways sometimes develop in elderly patients. If the situation permits, methods of testing such as optic nerve biopsy should be considered when optic nerve swelling continues to develop.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 122: 400-405, 2018.