Typical idiopathic optic neuritis

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Identifier EEC-Optic_Neuritis_with_OCT
Title Typical idiopathic optic neuritis
Subject optic neuritis, demyelination, optical coherence tomography, ganglion cell analysis
Creator Jonathan A. Micieli, MD Department of Ophthalmology, Emory University School of Medicine Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
Description 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.
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Relation is Part of Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management Copyright 2017. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
Holding Institution 2017-11
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
ARK ark:/87278/s6j42q9b
Format Creation Jonathan A. Micieli, MD, Valérie Biousse, MD. Copyright 2017. For further information regarding the rights to this collection, please visit http://library.med.utah.edu/NOVEL/about/copyright
Setname ehsl_novel_eec
Date Created 2017-11-30
Date Modified 2018-01-22
ID 1282772
Reference URL https://collections.lib.utah.edu/ark:/87278/s6j42q9b
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