Optic Perineuritis Presenting with Transient Monocular Vision Loss (TMVL): Case Report

Area of Science:

• Ophthalmology
• Neurology

Background:

• Optic perineuritis is an inflammatory condition affecting the optic nerve sheath, often presenting with decreased visual acuity and painful eye movements.
• Its symptoms can overlap with optic neuritis, potentially leading to diagnostic delays.
• Transient monocular vision loss (TMVL) has been rarely associated with optic neuritis but not previously reported in optic perineuritis.

Observation:

• A 30-year-old woman experienced recurrent, painless episodes of vision loss in her left eye, occurring up to 30 times daily.
• Ophthalmological examination and laboratory investigations were unremarkable.
• Magnetic resonance imaging revealed left optic nerve sheath enhancement, indicative of focal optic perineuritis.

Findings:

• The case demonstrates a unique presentation of optic perineuritis associated with transient monocular vision loss (TMVL).
• Despite normal initial findings, MRI confirmed optic nerve sheath enhancement.
• The patient responded to a short course of intravenous methylprednisolone.

Implications:

• This case underscores the importance of considering optic perineuritis in the differential diagnosis of TMVL.
• Accurate and timely diagnosis is crucial for effective management and reducing the risk of relapse and long-term visual morbidity.
• Prompt treatment with corticosteroids can be beneficial in managing optic perineuritis presenting with atypical symptoms.