Recovery of functional vision in a patient of papilledema following optic nerve sheath decompression surgery

A 17 year old female presented with complaints of headache over 1 year and painless loss of vision and restriction of lateral eye movements in both her eyes for the past 2 days. Her visual acuity was perception of light in her right eye and hand movements in left eye. Her pupils were dilated and fixed and her extraocular movements showed overall restriction. Her fundus showed papilledema. Neuro-imaging was done and she was diagnosed to have dural venous sinus thrombosis. She was treated appropriately by the physician and on no improvement in vision, she underwent optic nerve sheath decompression surgery in her right eye. Her visual acuity showed a dramatic improvement from perception of light to 6-9 in 10 months, with resolution of papilledema within 5 days. Her extra ocular movements regained control within 1 month. He contralateral eye also showed improvement from 6-24 to 6-6.Thus, this case shows that optic nerve sheath decompression is an effective way to treat acute papilledema in cases of dural venous sinus thrombosis.