Acute Optic Neuritis

Abstract

A 25-year-old male presented with complaints of retrobulbar pain in both eyes starting about 1 week ago. The pain worsened with movement of the eyes in either direction. One day after onset, the left eye became blurred, and the patient subsequently visited an ophthalmologist and was told he had disc edema. He received oral steroids 5 mg tid. However, his symptoms persisted, and he was referred to us. Ophthalmic examination showed corrected acuity of 6/6 in the right eye and CF at 10 cm in the left. Full and free range of eye movement was noted. The patient could identify 15 plates OD and only 1 plate OS using the Ishihara color test. The anterior segment was normal in both eyes, but RAPD sign was positive for the left eye. Hyperemic disc with mild blurred margin was also found in his left eye (Fig. 1.1). OCT demonstrated left disc edema with increased thickness of the peripapillary retinal nerve fiber layer (RNFL) (Fig. 1.2). Under the impression of optic neuritis, he was admitted for further examination. The patient’s peripheral blood examination showed negative findings in autoimmune and/or infectious diseases. Two days post-admission, vision in the right eye deteriorated to CF, with only one plate according to the Ishihara test. Intact peripapillary and disc capillary was found at early phase of fluorescein angiography, with dye staining on disc at late phase (Fig. 1.3). The visual field was near totally obscured (Fig. 1.4). MR imaging showed increased thickness of both optic nerves with contrast enhancement (Fig. 1.5).