Typical Idiopathic Optic Neuritis

This is a case of a typical optic neuritis in a 41-year-old woman presenting with vision loss and pain with eye movements in the right eye. Optic disc photos at presentation showed subtle hyperemia in the right eye (Figure 1) and optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) was mildly elevated in the right eye whereas OCT of the ganglion cell layer (GCL) was normal (Figure 2). Humphrey visual fields (24-2 SITA Fast) showed a cecocentral scotoma in the right eye (Figure 3) and MRI of the orbits (Axial T1 with fat suppression, post-contrast) showed enhancement of the right intraorbital optic nerve (Figure 4). MRI of the brain and spine were normal without any white matter lesions (Figure 5). She was treated with intravenous methylprednisolone 1 gram per day for 3 days followed by an oral prednisone taper and her vision returned to baseline after about 6 weeks. Optic disc photos 6 months after presentation showed temporal pallor in the right eye (Figure 6) and OCT of the RNFL showed temporal thinning and reduced macular GCL thickness in the right eye (Figure 7). Humphrey visual fields (24-2 SITA Fast) showed were normal in both eyes (Figure 8). OCT angiography was available for review and showed reduction in the superficial peripapillary capillary network temporally in the right eye corresponding to the area of RNFL thinning (Figure 9). Because her MRI of the brain was normal without any white matter lesions, her 15-year risk of multiple sclerosis in 25% based on the optic neuritis treatment trial. Figure 1. Optic disc photos at presentation showed subtle hyperemia in the right eye.; ; Figure 2. Optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) was mildly elevated in the right eye whereas OCT of the ganglion cell layer (GCL) was normal.; ; Figure 3. Humphrey visual fields (24-2 SITA Fast) showed a cecocentral scotoma in the right eye.; ; Figure 4. MRI of the orbits (Axial T1 with fat suppression, post-contrast) showed enhancement of the right intraorbital optic nerve.; ; Figure 5. MRI of the brain and spine were normal without any white matter lesions.; ; Figure 6. Optic disc photos 6 months after presentation showed temporal pallor in the right eye.; ; Figure 7. OCT of the RNFL showed temporal thinning and reduced macular GCL thickness in the right eye.; ; Figure 8. Humphrey visual fields (24-2 SITA Fast) showed were normal in both eyes 6 months after presentation.; ; Figure 9. OCT anriography was available for review and showed reduction in the superficial peripapillary capillary network temporally in the right eye corresponding to the area of RNFL thinning.