More than meets the eye?

Author: Fionn Bellis / Editor: Steve Fordham / Reviewer: Caitriona Considine, Srikanth Padmanabhan / Codes: O8 / Published: 26/07/2019

A previously healthy 28-year-old male accountant presents to the Emergency Department (ED) with pain in his left eye.

The pain has developed over the past 4-6 hours and is made worse with moving his eye. He has also noticed that eye movements are associated with a sensation of flashing lights. He describes colours as being dull and an overall sensation of blurred vision.

On examination there is a diminished afferent papillary response to light, a decrease in visual acuity, and a diminished central visual field (scotoma). The optic disc is however normal.

You make a clinical diagnosis of optic neuritis.

The patient describes a similar milder episode 8 months previously that resolved entirely in 2 days for which he did not receive any medical attention.

As this patient has recurrent symptoms of optic neuritis you suspect this may be a presentation of MS. On direct questioning, the patient reports symptoms of worsening fatigue for 18 months, which his GP has attributed to work-related stress. The previous summer he had a one week episode of tingling and weakness in his right arm which settled spontaneously. Full neurological examination is otherwise unremarkable other than a fine resting tremor in the left hand.

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