A 28 yo woman presents to your office complaining of eye pain in her right eye. What additional history do you want to obtain?
How long has the pain been there? (click to show/hide)
Do you have any associated symptoms? (click to show/hide)
Has this ever happened before? (click to show/hide)
Visual changes? (click to show/hide)
Medical history? (click to show/hide)
Neurological history? (click to show/hide)
Family history (click to show/hide) A 28 yo woman presents to your office complaining of eye pain in her right eye. What physical examinations would you like to perform?
VA (click to show/hide)
Visual fields (click to show/hide)
RAPD? (click to show/hide)
Fundoscopy (click to show/hide) A 28 yo woman presents to your office complaining of eye pain in her right eye. What is your leading diagnosis?
Ischemic optic neuropathy (click to show/hide)
Central retinal vein occlusion (click to show/hide)
Papilledema (click to show/hide)
Optic neuritis (click to show/hide) A 28 yo woman presents to your office complaining of eye pain in her right eye. What is the most likely diagnostic modality?
MRI (click to show/hide)
CT (click to show/hide)
Carotid US (click to show/hide)
LP (click to show/hide)
Genetic testing for senilin genes (click to show/hide) A 28 yo woman presents to your office complaining of eye pain in her right eye. What is your treatment plan for this patient?
Refer to neurology for management & workup if possible MS (click to show/hide)
Start steroids (click to show/hide)
Start immunosuppresants (click to show/hide)
Immediate NSG intervention (click to show/hide)
Reassure and allow home with follow up in 6 months. (click to show/hide) Optic neuritis is an important cause of acute visual loss. It can be associated with multiple sclerosis, and is the presenting symptom in 20% of MS patients. It is most common in women aged 20-40 yo, and follows the geographical distribution of MS (more common in temperate climates compared to tropical), more common in Caucasians. It is caused by acute demyelination of the optic nerve which leads to axon loss. Histologic features are typical of MS plaques including perivascular cuffing, myelin breakdown, and nerve sheath edema. These changes are thought to be T-cell mediated vs. a yet unknown target. B-cell activation vs. myelin basic protection has also been noted. Clinically, the presentation is usually monocular (90%), and vision loss occurs over hrs to days, peaks in 1-2 weeks, and usually affects central vision. Eye pain is present in 92% of patients and is worse on eye movement. There should be a RAPD if other eye uninvolved. If there is no RAPD, it is possible that the patient has a nonorganic cause of visual loss. Other features include a loss of color vision out of proportion to visual acuity loss, papillitis in 1/3 of patients, (which means that 2/3 of patients present with normal appearing optic nerve), and photopsias (flashes of light with eye movement) in 30% of patients.Q1
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Summary