Other important findings on examination are decreased central visual acuity (although all ranges of vision from 20/15 to no light perception may be present) and edema of the optic nerve head (in one-third of patients), which was not seen in this patient.
1Īn important finding on physical examination is a relative afferent pupillary defect, which is always seen in optic neuritis except in the rare instance of symmetric bilateral disease. 2 About one-third of patients also note photopsia. 1 The pain is thought to be due to mechanical irritation of the inflamed optic nerve. In most instances, the vision loss is associated with orbital pain (in 92%) that is worse with eye movements (in 87%). Patients present with subacute loss of vision that develops over hours or days. As was the case with this patient, the typical person with optic neuritis is young (mean age 32 yr), female (3:1 ratio of women to men) and white (> 75% of patients). (By convention, the term “optic neuropathy” will be used in this article when the cause of inflammation of the optic nerve is not demyelination.) Laboratory and imaging studies may be used for prognostic purposes, but they are not required. Optic neuritis is an inflammatory, demyelinating disease of the optic nerve typically diagnosed on clinical grounds without neuroimaging. Perform lumbar puncture to rule out infectious causes and for oligoclonal band screening of the cerebrospinal fluid (CSF)
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