Vision Loss as a Presenting Symptom of Vitamin B12 Deficiency.

Nutritional optic neuropathy is a rare and often overlooked factor leading to bilateral, symmetrical, and gradual visual impairment. This condition falls within the category of metabolic neuropathies. We documented a case involving bilateral nutritional optic neuropathy attributed to pancytopenia associated with vitamin B12 deficiency. A healthy 65-year-old Indian woman reported a bilateral, progressive, painless decline in vision over the past six months. She had a history of reduced oral intake for the preceding year and denied experiencing any gastrointestinal or constitutional symptoms. Bilateral visual acuity was 1/60. Examination revealed pale optic discs with attenuated vessels in both eyes and a cup-disc ratio of 0.3. The blood analysis showed low indices and a deficiency in serum vitamin B12. Despite undergoing treatment, her vision remained impaired due to the chronic nature of the condition. This case highlights the importance of identifying visual symptoms in an elderly woman experiencing malnutrition caused by inadequate dietary habits, which leads to bilateral nutritional optic neuropathy.

Bilateral Choroidal Osteoma in a Teenage Girl With Chronic Posterior Scleritis.

A 14-year-old girl with bilateral chronic posterior scleritis was referred to us for poor control of ocular inflammation. There was an incidental finding of choroidal osteoma bilaterally whereby the choroidal mass in her right eye demonstrated a significant tumor growth in a short duration of two months. The right eye choroidal tumor was orangy in color with a well-defined margin, two-disc diameter in size, and located at the macula encroaching the fovea. Multimodal imaging assessments, including serial color fundus photo, enhanced depth imaging optical coherence tomography (EDI-OCT), and B scan ultrasonography monitoring, confirmed a continuous rapid growth of choroidal osteoma with episodes of scleritis flare-ups. Furthermore, intolerance toward second-line immunosuppressants and loss of follow-ups during the coronavirus disease 2019 (COVID-19) pandemic lockdown led to frequent relapses of her posterior scleritis. Therefore, a new treatment plan was designed, and close monitoring of choroidal osteoma growth and control of posterior scleritis were initiated. Subsequently, bilateral posterior scleritis remained quiescent, and her vision remained stable with stagnant growth of choroidal osteoma.