Sudden vision loss in a young patient with an afferent pupillary defect, decreased color vision, no disc edema, and pain on eye movement consistent with retrobulbar optic neuritis confirmed on magnetic resonance imaging (MRI) to check for demyelinating lesions and treated as per the optic neuritis treatment trial with intravenous steroids. Optic neuritis refers optic neuropathy due to inflammation, demyelination, or infection. Typical cases generally only need an MRI to evaluate for demyelinating disease but atypical cases might require further evaluation for infectious and inflammatory etiologies including neuromyelitis optica (NMO) and myelin oligodendrocytic glycoprotein (MOG) antibodies.
A 35-year-old woman noted the acute onset of blurred vision in her right eye 12 days ago. She complained of moderately severe retro-orbital pain on the right that was made worse by eye movements. The vision had deteriorated over the first 3 or 4 days but had since stabilized. She noted that when she attempted to perform aerobic exercises, her vision became worse. She denied any precipitating factors for her visual loss or any history of neurologic symptoms, except for rare diffuse headaches for many years. She has been otherwise healthy and denies any family history of visual impairment.