IDIOPATHIC BILATERAL OPTIC PERINEURITIS IN A YOUNG MALAY MALE

Abstract

Background: Optic perineuritis (OPN) is a rare inflammation involving the meningeal sheath surrounding the optic nerve. Clinically it is difficult to differentiate OPN with optic neuritis, but it is critical to have an accurate diagnosis as both the diseases have different regime of treatment. Here we report a case of bilateral optic perineuritis in a young Malay male.

Case Report: A healthy 15 years old young Malay boy presented with subacute, painless and severe blurring of vision in his both eyes, worse on the right. Relative afferent pupillary defect was negative in both eyes. Patient had bilateral generalised optic disc swelling, which is more severe on the right eye. Typical feature of optic perineuritis (OPN) ‘doughnut sign’ was observed on magnetic resonance imaging. Connective tissue and infective screening were negative. He was diagnosed with bilateral idiopathic optic perineuritis. He was treated with high dose intravenous corticosteroids followed by a three-month course slow tapering of oral steroids. His vision and optic nerve function recovered.

Conclusion: Magnetic Resonance Imaging (MRI) is a vital diagnostic tool to diagnose optic perineuritis. Longer steroid treatment has to be given to prevent relapse of the disease and further damage to the optic nerve.

Keywords: Optic perineuritis, young male, distinguish between optic neuritis