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   Table of Contents      
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
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_610_18

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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 2023 Sep 25];66:895. Available from: https://journals.lww.com/ijo/pages/default.aspx/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)

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  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


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.

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Conflicts of interest

There are no conflicts of interest.

  References Top

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
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
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
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


  [Figure 1]

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