Clinical Manifestations and Treatment of Idiopathic Optic Perineuritis

ABSTRACT

PURPOSE: To investigate the clinical and radiologic manifestations of idiopathic optic perineuritis (OPN), and to evaluate the outcomes of steroid treatment for OPN. METHODS: We reviewed the medical records and radiologic findings of 10 patients (13 eyes) who were diagnosed with OPN and treated with steroid. RESULTS: The mean age was 56.5 +/- 9.3 years (range, 35-77 years) and the sex ratio was equal. The main complaint was decrease in visual acuity combined with ocular pain during extraocular eye movement in 9 patients. The median visual acuity at the first visit was 0.2 (HM-0.8) and the relative afferent papillary defect was observed in 12 eyes. Additionally, combined orbital diseases included posterior scleritis in 1 eye and myositis in 1 eye. Orbit magnetic resonance imaging (MRI) scans demonstrated intraorbital optic nerve sheath enhancement in all patients, occasionally with orbital fat involvement. All patients demonstrated improved visual acuity after high-dose oral steroid therapy (6 patients) or intravenous (IV) pulse steroid therapy (4 patients). Relapse occurred in 4 patients during steroid tapering. CONCLUSIONS: The population in this study was composed predominantly of patients with OPN in their 50's. The primary symptom of OPN was visual acuity decrease combined with ocular pain during extraocular eye movement. Radiologically, orbit MRI scans demonstrated intraorbital optic nerve sheath enhancement. The patients in this study demonstrated good responses to steroid treatment, but clinicians must be aware of the high recurrence rate during steroid tapering in this condition. A combination of clinical and radiologic findings was helpful to diagnose OPN.