Idiopathic optic perineuritis: Disguised as recurrent optic neuritis

Abstract

A 53-year-old woman with history of mitral valve prolapse and astroesophageal reflux, presented to the Emergency Department ith right eye pain and blurry vision for 2 days. She had acute onset f retro-orbital pain and headache, eye pain with eye movement ut no nausea or vomiting. She also reported seeing gray spots and ad ‘blurry vision’ in the right eye. She reported that the temporal isual field was entirely gray in the right eye. She had no prior visual ymptoms and no family history of eye disease. She had no other eurological complaints. Her neurological examination showed extra ocular movements o be intact. She had a relative afferent pupillary defect in the right ye. On Humphrey 24-2 visual field, she had an enlarged blind spot nd constriction peripherally. On ophthalmoscopic examination he patient had disk swelling in the right eye (Fig. 1). There were no emorrhages or exudates. There was pain on eye movement. The emainder of her neurological and general physical examination as normal. Patient was admitted for evaluation of what was thought to be ptic neuritis. MRI brain with and without contrast did not reveal ny lesions suggestive of multiple sclerosis or other demyelinating isease. Lumbar puncture was normal. She was started on high dose