Internal limiting membrane detachment associated with papilloedema following brain metastasis in a child with Ewing sarcoma

Abstract

This case report presents initial and follow-up findings of a rare case of bilateral internal limiting membrane (ILM) detachment and sub-ILM hemorrhage in a 7-year-old child with Ewing sarcoma, associated with papilloedema due to a brain metastasis and the use of optical coherence tomography (OCT) in the evaluation and follow-up. The child was diagnosed with Ewing sarcoma and she was referred to the ophthalmology clinic because of blurry vision, anisocoria, and strabismus one week after the operation for brain metastasis. Fundus examination showed bilateral grade IV papilloedema, well-defined dome-shaped area extending towards the optic discs with inferiorly located hemorrhage. OCT revealed bilateral ILM detachment surrounded with a ring-shaped retinal elevation and inferiorly located sub-ILM hemorrhage. On the follow-up examinations OCT showed decrease of height of ILM detachment with resolution of sub-ILM hemorrhage. ILM detachment associated with papilloedema due to a brain metastasis is an exceedingly rare occurrence, making this case particularly significant in understanding ocular manifestations of intracranial pathology. OCT plays a crucial role in diagnosing and monitoring the progression of ILM detachment and associated sub-ILM hemorrhage, offering invaluable insights into the pathophysiology of raised intracranial pressure. Recognizing ocular signs such as papilloedema is critical for early detection of intracranial complications in pediatric patients.