AUG 27, 2012
Optic Neuritis . . . or Not?
By Roger E. Turbin, MD
Subspecialty Day 2011: Neuro-Ophthalmology
Neuro-Ophthalmology/Orbit
This case discussion from Neuro-Ophthalmology Subspecialty Day 2011 illustrates just how difficult it may be on initial presentation to distinguish optic neuritis from mimickers. Dr. Roger Turbin describes a 30-year-old man who presented with sudden blurry vision, ipsilateral pain with eye movement, and discomfort radiating from the right eye to his temple. The right optic nerve, initially flat and hyperemic at presentation, developed optic disc edema with mild 360-degree nerve elevation and nerve fiber layer edema by the third day. Optic neuritis was suspected, and intravenous and oral prednisone were offered. Visual acuity, visual field, dyschromatopsia, and optic disc swelling normalized. Three weeks after the prednisone was tapered, however, ipsilateral pain returned, vision decreased to counting fingers, and visual field dramatically worsened in the right eye. The patient was diagnosed with an atypical case of Devic’s disease (neuromyelitis optica), and 9 years later his bilateral vision is reduced to no light perception. Dr. Turbin suggests that a chronic, recurring disease process or corticosteroid dependence should prompt re-evaluation for disorders other than demeylinating optic neuritis.