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Questions Answered: 300

Final Score 76%

229
71

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Ophthalmology

Question 154 of 300

A 37 year old woman presents to the Emergency Department complaining of decreased vision in the left eye over the last 2 days. On examination you find a decreased visual acuity (VA) in the left eye, with normal VA in the right. On visual field testing you find a scotoma in the left eye. Fundoscopy of the right eye is normal, in the left eye you feel the optic disc is swollen. What is the most likely diagnosis?

Answer:

Clinical features of optic neuritis:
  • 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)

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
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