Age: 7.0
Sex: M
Vaccine: VARCEL
Symptoms: Eye haemorrhage, Optic neuritis, Scotoma, Visual acuity reduced, Visual field defect
Clinical narrative: On 1/31/00, the pt experienced decreased vision of both eyes and hemorrhage of left optic nerve. He was seen by an eye doctor. The pt was hospitalized. He was dx with bilateral sequential optic neuritis. He was treated for visual field deficits, bilateral central scotoma, and optic neuropathy bilaterally. The symptoms were considered disabling.  Follow up 06/26/2001: "Information has been received from a physician concerning a 7 year old Caucasian male who on 01/31/2000 was vaccinated IM with one dose of varicella virus vaccine live (Lot # 632611/1855J).  There was no concomitant medication.  On approximately 01/31/2000 the patient experienced decreased vision of both eyes.  20/400 right and 20/150 left, and hemorrhage of left optic nerve.  He was seen by an "eye doctor".  An MRI and multiple laboratory tests were negative.  The patient was hospitalized.  He was diagnosed with bilateral sequential optic neuritis.  He was treated for visual field deficits, bilateral central acotoma and optic neuropathy bilaterally.  The patient was seen in follow up on 05/11/2000.  He stated he saw more black spots.  Left greater than right eye for approximately one week.  He was off the prednisone.  He had not been playing baseball at school.  Uncorrected acuity during examination was 20/100-1 with no improvement on pinhole in the right eye.  In the left eye he saw 20/40-1 with not improvement on pinhole.  He saw all Ishihara color plates in both eyes.  The pupils were 3mm, round, and reactive to light without afferent defect.  On stereo testing, he could see the bug but none of the smaller stereo cues.  Intraocular pressure in the right eye was 10 and 12 on the left.  Slit lamp examination was otherwise unremarkable.  Nondilated fundus examination was performed.  The right disc was no longer swollen.  The inferotemporal aspect was somewhat elevated but not swollen.  In the left eye, there may have been some shallow temporal cupping with an area of focal pallor at the temporal margin of the disc.  There was no hemorrhage.  His cranial nerve examination and neurological examination were otherwise unchanged and normal.  Given his complaints, visual field testing was performed again and compared to prevoius examinations.  In the right eye, he had a relatively dense cecocentral scotoma worse temporally which although fluctuated in location from examination to examination.  Was probably similar over the previous two months but was better than the initial examination in February 2000.  In the left eye, he had a cecocentral scotoma which looked like it had an inferior extension of unknown significance.  He always had moderate variance with anywhere from 5-10% false positives and false negatives.  The ophthalmologist believed that within the limits of the examination for his age, the fiedls were stable.  The patient was reported to have acuity in both eyes which improved since the last examination.  His discs were no longer swollen and were better when compared to the appearance of photographs that were performed at the onset of the event.  The ophthalmologist was concerned that the left eye returned asymmetrically in the face of a moderate hyperopic refractive asymmetric situation.  The patient was seen again on 08/10/2000.  He was seen in follow up for his bilateral optic neuropathy which was either a primary bilateral optic neuritis, or parainfectious, or paravaccination optic neuropathy.  He was also followed by another ophthalmologist who felt glasses were not necessary at the time.  His visual acuity was 20/80- in the right eye without correction and 20/40 in the left eye. He saw all Ishihara color plates.  The pupils were 3mm round and reactive to light without afferent defect.  The slit lamp examination was unchanged with 1 mm of slight upper lid droop with normal levator function and an old resected cyst in the left lower lid.  Ductions were full, although he had a flick of ET in primary.  Both discs had some pallor, more inferotemporally in the right eye with possibly a slightly small nerve.  The was slight RPE stippling, but otherwise the macula, retina, and vitreious were normal.  Visual fields were performed and had bilateral cecocentral scotomas which were similar to past scans.  The symptoms were considered disabling.  He had partial recovery fromt he symptoms as of 08/13/2000.  No further information is available."