A Case of Orbital Meningioma Misdiagnosed as Non-arthritic Ischemic Optic Neuropathy

A 62-year-old woman with hypertension, dyslipidemia, and mild cognitive impairment presented for a second opinion of her left eye visual loss for three months. She initially noticed a black spot in the lower visual field of her left eye and sought care from her local ophthalmologist. At that time, she was diagnosed with non-arteritic ischemic optic neuropathy (NAION) and recommended to follow up with her family doctor for vascular risk factor control. However, her left eye vision gradually deteriorated over the ensuing months. She denied eye pain or headache. During her eye examination, decreased visual acuity and color vision were noted in her left eye, along with a left relative afferent pupillary defect (RAPD). The examination of the front part of the eye using a slit lamp revealed normal findings, while the fundus examination indicated pallor of the optic nerve in the left eye. Subsequent orbital MRI with and without gadolinium contrast revealed the presence of a meningioma in the left sphenoid-orbit region. Following the surgical removal of the meningioma, the patient experienced a significant improvement in vision in her left eye. This case underscores the significance of utilizing orbital MRI in individuals with optic neuropathy.[1] Surgical intervention to relieve compression could lead to a favorable visual outcome.[2]