Adult-onset bilateral optic neuritis: a rare presentation

A rare case of adult-onset bilateral optic neuritis without associated autoimmune or infectious disorders has been reported in this study. A 19-year-old male described sudden bilateral diminution of vision (sequential) with headache with no other remarkable history. Ophthalmological findings revealed asymmetrically reduced visual acuity on the initial visit. Fundus examination showed nerve fibre layer oedema (more in right eye). Radiological examination was suggestive of bilateral, asymmetrical optic neuritis. Visual evoked potential tests suggested asymmetrical and sequential P100 delay. No auto-immune/infectious aetiology was found. The condition was diagnosed as an atypical presentation of optic neuritis with sequential bilateral involvement. Patient was treated with intravenous methyl prednisolone followed by tapering oral doses owing to the bilaterality of the involvement. A careful follow-up is being performed. The condition involving bilateral inflammation of the optic nerves can have hazardous outcome and hence prompt, careful and comprehensive diagnostic and treatment approach is necessitated.