Retinal folds as initial manifestation of orbital lymphangioma.

Comment. The chorioretinal lesions seen in our patient are similar to, but much more extensive than, those described in previous articles. We presume that the severity of both the neurological and the chorioretinal involvement in our patient is associated with immune compromise related to senescence and diabetes mellitus. In contrast to our patient, previously described patients with ocular involvement by West Nile virus have suffered less initial visual loss and have usually enjoyed visual improvement during disease resolution. The severity of the visual loss in the present case is clearly related in part to the degree of chorioretinal damage seen clinically and angiographically. However, the mild to moderate changes in electroretinography responses do not support visual loss to the lightperception level. In the context of such profound visual loss, the electroretinography findings, reactive pupils, and healthy-appearing optic discs suggest that retrogeniculate damage is likely a contributing morbidity. Because routine magnetic resonance image scanning has failed to show structural damage in this area, functional magnetic resonance imaging studies are planned.