Glyxambi
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 1182
  • Home
  • Print this page
  • Email this page


 
   Table of Contents      
ONE MINUTE OPHTHALMOLOGY
Year : 2018  |  Volume : 66  |  Issue : 7  |  Page : 895

Typical optic neuritis?


Pediatric Ophthalmology and Strabismology Services, Narayana Nethralaya, Narayana Health City, Bengaluru, Karnataka, India

Date of Web Publication25-Jun-2018

Correspondence Address:
Jyoti Matalia
Pediatric Ophthalmology and Strabismology Services, Narayana Nethralaya, Narayana Health City, Bengaluru, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_610_18

Rights and Permissions

How to cite this article:
Matalia J, Dinakaran S, Anaspure H. Typical optic neuritis?. Indian J Ophthalmol 2018;66:895

How to cite this URL:
Matalia J, Dinakaran S, Anaspure H. Typical optic neuritis?. Indian J Ophthalmol [serial online] 2018 [cited 2018 Nov 14];66:895. Available from: http://www.ijo.in/text.asp?2018/66/7/895/234988




  Case Top


A 20-year-old lady presented with complaints of decreased vision in the left eye (OS) with pain on eye movements of 3 days duration. There was no associated systemic history. On examination, best-corrected visual acuity was 6/5 in right eye (OD) and 6/18 in OS with reduced contrast sensitivity and red-green color defect. Ocular motility was normal in both eyes. Pupillary examination revealed grade 2 relative affarent pupillary defect (RAPD) in OS. OD was essentially normal. Fundus examination showed blurred disc margins in OS [Figure 1]a with an inferior altitudinal and superotemporal visual field defect on Humphrey 30-2 program (SITA-standard) [Figure 1]b.
Figure 1: Blurred optic disc margin OS (a) and inferior altitudinal and superotemporal visual field defect (b) with thickening of the posterior part of the laterla rectus on axial MRI (c) and a cyst with scolex on sagittal MRI (d)

Click here to view



  What is Your Next Step? Top


  1. Start conservative treatment with course of systemic corticosteroids
  2. Magnetic resonance imaging (MRI) brain and orbit with contrast
  3. Wait and watch for natural recovery
  4. Refer to a neurologist for further management


Findings

MRI of the orbit (1.5 Tesla) revealed a thickening in the most posterior part of the left lateral rectus muscle close to its origin [Figure 1]c, yellow arrowhead]. The T2-weighted sagittal sections clearly demonstrated a ring enhancement and central bright signal, suggesting a scolex [Figure 1]d, yellow arrowhead] and possibly cysticercosis of the left lateral rectus muscle crowding the left orbital apex, and compressing the optic nerve. Treatment with oral albendazole and corticosteroids was initiated. One month later, she regained vision of 6/5 OS with normalization of her color vision, contrast sensitivity, and visual field.


  Diagnosis Top


Compressive optic neuropathy secondary to orbital myocysticercosis OS.


  Correct Answer: B. Top



  Discussion Top


Orbital cysticercosis typically presents with conjunctival injection, ocular motility disorder and ptosis.[1],[2],[3],[4] This young girl with features of left optic neuropathy had pain on eye movements and edema of the left optic nerve fulfilling the criteria of classic optic neuritis. However, even with such typical presentation, it is important to consider cysticercosis as a masquerade, especially in endemic areas. Cysticercosis can respond to oral albendazole and corticosteroids, but before its initiation, MRI orbit with evaluation of thin cuts should be ordered to confirm the diagnosis. This case report highlights a rare presentation of myocysticercosis simulating optic neuritis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kaliaperumal S, Rao VA, Parija SC. Cystcercosis of the eye in South India- a case series. Indian J Microbiol 2005;23:227-30.  Back to cited text no. 1
    
2.
Prasad R, Bagri N, Mishra OP, Singh MK. Proptosis of eyeball in children with medial rectus cysticercosis: Report of 2 cases. Eur J Ophthalmol 2010;20:240-2.  Back to cited text no. 2
[PUBMED]    
3.
Mohan K, Saroha V, Sharma A, Pandav S, Singh U. Extraocular muscle cysticercosis: Clinical presentations and outcome of treatment. J Pediatr Ophthalmol Strabismus 2005;42:28-33.  Back to cited text no. 3
[PUBMED]    
4.
Rath S, Honavar SG, Naik M, Anand R, Agarwal B, Krishnaiah S, Sekhar GC. Orbital cysticercosis: clinical manifestations, diagnosis, management, and outcome. Ophthalmology. 2010;117:600-5  Back to cited text no. 4
    


    Figures

  [Figure 1]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Case
What is Your Nex...
Diagnosis
Correct Answer: B.
Discussion
References
Article Figures

 Article Access Statistics
    Viewed753    
    Printed4    
    Emailed0    
    PDF Downloaded391    
    Comments [Add]    

Recommend this journal