Acute-Onset Retinal Conditions Mimicking Acute Optic Neuritis: Overview and Differential Diagnosis.

Acute optic neuritis (AON) is a common cause of sudden visual loss in young patients. Because of the risk of demyelinating disease, patients affected by unilateral or bilateral optic neuritis should be evaluated and treated accordingly. Despite advancements in imaging of the brain and retina, misdiagnosis of AON is not uncommon. Indeed, some acute disorders of the retina have the potential to mimic AON and their prompt diagnosis may avoid unnecessary neurologic investigation, psychological stress to the patient, and delays in treatment. This review describes uncommon retinal disorders presenting with sudden-onset visual loss and absent or subtle funduscopic manifestation that can mimic AON. Multimodal retinal imaging is essential in detecting these conditions and in their differential diagnosis. It behooves neurologists and general ophthalmologists to be aware of these entities and be familiar with multimodal imaging of the retina.

Unilateral Compressive Optic Neuropathy As the Presenting Manifestation of Clival Chordoma: A Case Report.

The optic nerve(s) may be compressed by a number of intracranial and intraorbital masses. Compression may be isolated to the optic nerve or may involve other intracranial or intraorbital structures with variable presentation. A 26-year-old man presented with complaints of progressive painless visual loss in the right eye for eight months. Examination revealed isolated unilateral optic atrophy consistent with a diagnosis of compressive optic neuropathy. Magnetic resonance imaging of the brain showed compression of the anterior visual pathways due to a lesion radiologically compatible with clival chordoma. He underwent subtotal neurosurgical resection and pathology was consistent with chordoma. Although rare, isolated unilateral visual loss may be the only presenting manifestation of clival chordoma.

Topical Nerve Growth Factor for the Treatment of Neurotrophic Keratopathy Caused by Wallenberg Syndrome.

PURPOSE: The aim of this study was to report a case of central neurotrophic keratopathy (NK) in Wallenberg syndrome (WS) and its successful management with topical recombinant nerve growth factor (rNGF). METHODS: A 47-year-old man with WS caused by a stroke in the territory of the left vertebrobasilar artery complained of progressive visual loss in his left eye (OS). Examination showed corneal anesthesia associated with a corneal epithelial ulceration consistent with a diagnosis of NK grade 3 of central origin. Topical treatment with rNGF, 1 drop 6 times daily, was started for 8 weeks, and the patient was followed up for 1 year. RESULTS: Topical treatment with rNGF was successful in promoting complete epithelial corneal healing. No recurrence was seen at 1-year follow-up. CONCLUSIONS: Clinicians should be aware that visual loss can also occur from NK of central origin. To the best of our knowledge, this is the first case report of NK caused by WS successfully treated with rNGF reported in the literature.

Should "Retro-ocular Pain, Photophobia and Visual Acuity Loss" Be Recognised as a Distinct Entity? The ROPPVAL Syndrome.

Unilateral retro-ocular pain, photophobia and visual disturbance in patients suspected as having acute optic neuritis was described as a distinct clinical entity by Jefferis et al. in 2018. We hereby report a further four patients with the same clinical phenotype and propose the term ROPPVAL syndrome (Retro-Ocular Pain, Photophobia and Visual Acuity Loss). All of them had a previous (mis)diagnosis of optic neuritis. All of the patients had normal ocular and neurological examinations, no relative afferent pupillary defect and no objective structural abnormality was identified. We also discuss possible mechanisms, the role of cycloplegics that we found to be useful in reducing symptoms, and the importance of distinguishing this syndrome from optic neuritis.