A 58-year-old African American man presented to the ophthalmic oncology clinic after referral from a community physician who noted bilateral calcified lesions of the optic nerves on a CT scan performed for dizziness (figure 1). The patient reported no recent change in his vision and had no complaints. His dizziness had resolved spontaneously by the time of our encounter. He denied headache, visual field changes and diplopia. He reported having a normal eye exam 2 years previously. His past medical history included only hyperlipidaemia and osteoarthritis. He denied any history of malignancy or kidney disease.

Physical examination revealed 20/15 vision bilaterally, normal intraocular pressures, equal and reactive pupils with no afferent pupillary defect, normal motility and alignment and no proptosis. Both optic nerves had a normal appearance with no swelling, pallor or cupping. The remainder of his funduscopic examination was normal. There were no visual field defects. Colour vision was assessed with Ishihara plates and was normal. He then underwent B-scan ultrasonography to assess his optic nerves (figure 2). …