Published: 2019-03-27

Adult-onset bilateral optic neuritis: a rare presentation

Sangeeta Gupta, Amit Raj, Ramji Singh, Gaurav Gupta


A rare case of adult-onset bilateral optic neuritis without associated autoimmune or infectious disorders has been reported in this study. A 19-year-old male described sudden bilateral diminution of vision (sequential) with headache with no other remarkable history. Ophthalmological findings revealed asymmetrically reduced visual acuity on the initial visit. Fundus examination showed nerve fibre layer oedema (more in right eye). Radiological examination was suggestive of bilateral, asymmetrical optic neuritis. Visual evoked potential tests suggested asymmetrical and sequential P100 delay. No auto-immune/infectious aetiology was found. The condition was diagnosed as an atypical presentation of optic neuritis with sequential bilateral involvement. Patient was treated with intravenous methyl prednisolone followed by tapering oral doses owing to the bilaterality of the involvement. A careful follow-up is being performed. The condition involving bilateral inflammation of the optic nerves can have hazardous outcome and hence prompt, careful and comprehensive diagnostic and treatment approach is necessitated.


Optic neuritis, Visual acuity, Visual evoked potentials

Full Text:



Boomer JA, Siatkowski RM. Optic neuritis in adults and children. Semin Ophthalmol. 2003;18(4):174-80.

Shams PN, Plant GT. Optic neuritis: a review. Int MS J. 2009;16(3):82–9.

Menon V, Saxena R, Misra R, Phuljhele S. Management of optic neuritis. Indian J Ophthalmol. 2011;59(2):117–22.

Pau D, Al Zubidi N, Yalamanchili S, Plant GT, Lee AG. Optic Neuritis Eye. 2011;25(7):833–42

Voss E, Raab P, Trebst C, Stangel M. Clinical approach to optic neuritis: pitfalls, red flags and differential diagnosis. Ther Adv Neurol Disord. 2011;4(2):123–34.

Foroozan R, Buono LM, Savino PJ, Sergott RC. Acute demyelinating optic neuritis. Curr Opin Ophthalmol. 2002;13(6):375–80

Blanco TA, Aliseda D, Ajuria I, Zandio B, Mayor S, Navarro MC. Inflammatory optic neuritis. An Sist Sanit Navar. 2009;32(2):249–63.

Klistorner A, Arvind H, Nguyen T, Garrick R, Paine M, Graham S, et al. Axonal loss and myelin in early ON loss in postacute optic neuritis. Ann Neurol. 2008;64(3):325.

Balcer LJ. Clinical practice. Optic neuritis. N Engl J Med. 2006;354(12):1273–80.

Sethi H, Sharma P, Tandon R, Khokhar S, Menon V. Visual outcome after intravenous dexamethasone therapy for idiopathic optic neuritis in an Indian population: A clinical case series. Indian J Ophthalmol. 2006;54(3):177–83.

You Y, Klistorner A, Thie J, Graham SL. Latency Delay of Visual Evoked Potential Is a Real Measurement of Demyelination in a Rat Model of Optic Neuritis, Investigative Ophthalmol Visual Sci. 2011;52(9):6911.

Jones SJ. Visual evoked potentials after optic neuritis. Effect of time interval, age and disease dissemination. J Neurol. 1993;240:489-94.