Inflammatory optic neuritis and scleritis following commencement of semaglutide: a case report

Given the documented increased risk of non-arteritic ischaemic optic neuropathy (NAION), the widespread use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has raised concerns regarding their ophthalmic safety. This study presents a unique case of inflammatory optic neuritis and scleritis in a 43-year-old female one month following commencement of semaglutide. Extensive investigations for underlying systemic causes, including autoimmune and connective tissue disorders were negative. Treatment with systemic corticosteroids led to a gradual resolution of symptoms and return of vision to baseline over a three-month period. This case highlights a potential link between semaglutide and inflammatory ocular conditions. Clinicians should maintain an open mind when evaluating optic neuropathies in the context of GLP-1 RA use and consider corticosteroid-responsive inflammatory aetiologies as alternatives to NAION. Multicentre population-based cohort studies are warranted to determine whether a true association exists and to elucidate the potential mechanisms underlying semaglutide-associated ocular inflammation.