Silicone oil chiasmal syndrome: an atypical vitreoretinal complication

Abstract

Purpose: Present a case-based rare post-vitrectomy complication secondary to silicone oil (SO) migration through the visual pathway, to the central nervous system (CNS).
Case report: A 75-year-old woman consulted for acute decreased visual acuity (VA) in her left eye (OS), with history of stable glaucoma but IOP peaks in her right eye and no light perception after vitrectomy with SO 14 months prior. She had bilateral disc cupping and visual field loss compatible with a chiasmal syndrome. Magnetic resonance images showed SO in the visual pathway with progression to the intracranial subarachnoid space and into the ventricles, recovering VA and visual field (VF) in contralateral eye (OS) after the combined antiinflamatory corticotherapy and the ocular SO extraction in the right eye in order to discontinue the leakage inside the CNS.
Conclusions: Silicone oil optic neuropathy may be more frequent than diagnosed. It is therefore advisable to perform urgent neuroimaging studies in patients with optic disk risk factors (cupping, congenital anomalies) associated to otherwise unexplained visual incoveniences in the fellow eye after a successful vitrectomy, since a neurosurgery could be avoided.