Optic perineuritis secondary to Wegener's granulomatosis

Clin Exp Ophthalmol. 2009 Sep;37(7):712-7. doi: 10.1111/j.1442-9071.2009.02122.x.

Abstract

Background: Optic perineuritis (OPN) is an inflammatory condition involving the optic nerve sheath because of a variety of causes. We describe three patients in whom OPN was secondary to Wegener's granulomatosis (WG) and compare the clinical findings in these cases with those of idiopathic OPN.

Methods: This is a retrospective small case series derived from patients with OPN seen in an outpatient neuro-ophthalmology clinic. Medical records and imaging studies of these patients were reviewed.

Results: These patients shared clinical similarities with idiopathic OPN including age, sex, symptoms, radiographic findings and steroid responsiveness. However, recurrence of symptoms on lowering the prednisone dose below 40 mg distinguished these patients from those with idiopathic OPN.

Conclusions: Steroid dependency in idiopathic OPN should raise suspicion of WG. Patients with OPN should be specifically questioned regarding pre-existing upper respiratory tract disorders and rheumatic symptoms and laboratory testing should include acute phase reactants, anti-neutrophil cytoplasmic antibodies and tests of renal function.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Female
  • Glucocorticoids / therapeutic use
  • Granulomatosis with Polyangiitis / complications*
  • Granulomatosis with Polyangiitis / diagnosis
  • Granulomatosis with Polyangiitis / drug therapy
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Optic Neuritis / diagnosis
  • Optic Neuritis / drug therapy
  • Optic Neuritis / etiology*
  • Orbit / pathology
  • Prednisone / therapeutic use
  • Retrospective Studies

Substances

  • Glucocorticoids
  • Prednisone