Ophthalmology
Question 176 of 180
A 42 year old woman presents to the Emergency Department complaining of increasing visual loss in her left eye over the last 5 days. She describes retro-ocular pain that is exacerbated by movement of the eyes. She describes colours as looking "washed out". Which of the following conditions is associated with the most likely diagnosis in this patient?
Answer:
The patient has features of optic neuritis. Optic neuritis (ON) is inflammation of the optic nerve. By far the most common form is idiopathic ON, which is a primary demyelinating disease occurring in isolation or as part of multiple sclerosis (MS).Optic Neuritis
Ophthalmology
Last Updated: 8th September 2021
Optic neuritis (ON) is inflammation of the optic nerve. By far the most common form is idiopathic ON, which is a primary demyelinating disease occurring in isolation or as part of multiple sclerosis (MS).
Risk factors
- Age 30 - 50 years
- Female gender
- White ethnicity
Clinical features
- Symptoms
- Partial or total unilateral visual loss occurring over several days
- Periorbital/retro-ocular pain exacerbated by eye movements
- Colour desaturation/loss of colour vision
- Signs
- Reduced visual acuity with a scotoma affecting central vision
- Decreased ability to differentiate colours (using Ishihara charts)
- Relative afferent pupillary defect
- Optic disc swelling (may or may not be present)
Management
- Urgent ophthalmology referral
- MRI of the optic nerves - findings support the diagnosis of optic neuritis (ON) and rule out other causes of optic nerve damage such as compressive neuropathy, also helpful for predicting conversion to clinically definite multiple sclerosis (CDMS)
- Treatment is usually with corticosteroid therapy
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
