Walsh & Hoyt: Paraneoplastic Optic Neuropathy

Paraneoplastic optic neuropathy results in a subacute, progressive, bilateral loss of vision, usually without accompanying pain. The optic disc is edematous or normal in appearance. The optic chiasm can also be involved. Associated findings include cranial nerve palsies, polyneuropathy, vertical or down-beating nystagmus, and cerebellar signs. Direct compression or infiltration of the optic nerves and ischemic optic neuropathy must be ruled out. Paraneoplastic optic neuropathy is very rare. As of 2002, only 18 cases of paraneoplastic optic neuropathy had been reported. Neuropathologic findings reveal nonspecific vascular infiltration of the optic nerve by lymphocytes as well as axonal loss or demyelination of the optic nerve. Paraneoplastic optic neuropathy can also be associated with a subacute cerebellar syndrome.