The approach to bilateral simultaneous isolated optic neuritis

In this issue of BJO (p 551), de la Cruz and Kupersmith describe a series of 15 adult patients who presented to a neuro-ophthalmic referral practice over a 5 year period with bilateral simultaneous optic neuritis. Patients were not included in this series if they had either evidence of multiple sclerosis or myelopathy, a known systemic disease or medication that is associated with optic neuropathy, or cancer. They were evaluated for systemic disease by a battery of testing including lumbar puncture, which was abnormal in two patients. They indicate that in one case, their patient was ultimately shown to have sarcoidosis, the others did not have a specific diagnosis made (although three (20%) were thought to be post-viral). Their data show that most of these cases have a good outcome when treated with their recommended corticosteroid regimen of 3–5 days of intravenous methylprednisolone 1 g daily followed by a taper of oral prednisone tailored to the clinical course.

Fortunately, the presentation with bilateral simultaneous optic neuritis in adults is unusual, yet because of the devastating implications for the patient, possibly including occult yet active systemic disease, these patients require keen attention from the first ophthalmologist to contact them.

The key to applying the data in this paper to a patient you might encounter is to know if the entry criteria apply

The key to applying the data in this paper to a patient you might encounter is to know if the entry criteria apply. Certainly, a history and examination to rule out occult demyelinating disease is a given, and if a drug that causes optic neuropathy is being used, it will immediately be a suspect cause. If the patient has a known neoplasm, then one will carefully search …