Optic nerve enhancement in Coats disease with secondary glaucoma

Differentiating between Coats disease and retinoblastoma can be challenging. Magnetic resonance imaging typically is obtained when retinoblastoma is suspected to evaluate for a mass or optic nerve infiltration, the latter appearing as an enhancing lesion. We report a case of optic nerve enhancement observed in the setting of an acute secondary glaucoma in a patient with unilateral Coats retinopathy. Given the gravity of the decision to recommend enucleation on the basis of clinical findings consistent with retinoblastoma, physicians must be aware of the possibility of optic nerve enhancement in the setting of inflammation and raised intraocular pressure.