Idiopathic Optic Perineuritis Presenting as Acute Hemifield Loss: Importance of Early MRI Diagnosis and Steroid Therapy
Keywords:
optic perineuritis, acute visual loss, corticosteroid therapyAbstract
Optic perineuritis (OPN) is a rare inflammatory condition involving the sheath of the optic nerve. Although it may present similarly to optic neuritis, it requires distinct management approaches. A 27 years old man, came to the eye clinic with left eye visual field defect and pain on eye movement for three days. His left eye vision was counting finger and 6/6 in right eye. Relative afferent pupillary defect (RAPD) present in the left eye. He had some difficulty perceiving colours. The intraocular pressures were within normal limits bilaterally. Anterior and posterior segments examination on both eyes were unremarkable. Tests for antibodies against the water channel protein 4 (AQP4) and the oligodendrocyte myelin glycoprotein (MOG) were negative, effectively ruling out neuromyelitis optica spectrum disorder (NMOSD) and MOG antibody-associated disorder (MOGAD). Screening for infectious and autoimmune diseases were also unremarkable. Orbital MRI showed marked contrast uptake along the left optic nerve with extension into the canal of optic nerve, confirming the diagnosis of optic perineuritis. He was treated with intravenous high-dose methylprednisolone, followed by a gradually reducing course of oral steroids, resulting in full recovery of vision and colour perception within one week. This case underscores the importance of early suspicion of optic perineuritis. Urgent referral to tertiary centres with MRI facilities can help ensure accurate diagnosis and timely treatment. Early initiation of corticosteroid therapy plays a key role in preserving vision and preventing permanent visual damage.
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