The case study patient

The patient a 28-year-old Hispanic female, 2 weeks post-partum and alternating between breastfeeding and formula feeding, was referred to me for decreased vision OS of unknown etiology. 

When the optometrist saw her, OD BVA was 20/20 and OS BVA was 20/40. When I saw her 2 days later, the vision was still normal OD, as was the VF, but the OS BVA was now CF with an APD, complete loss of VF and red color desaturation. The ocular exam was WNL without apparent ONH edema of either eye. VF and OCT NFL imaging attached

A classic case of optic neuritis OS

The patient is a young female and this demographic is typical for optic neuritis. An MRI of the brain and orbits was ordered with and without contrast and Flair sequencing, which illustrated the optic neuritis OS, but no demyelinating plaques, typical for multiple sclerosis, were found.  

After a discussion with her OB-GYN, we ordered intravenous methylprednisolone 1000mg via home health for 3 days and followed up with a round of oral steroids as per the Optic Neuritis Treatment Trial. During the steroids, the patient had to “pump and dump” her breast milk and exclusively use formula while on steroids.

The patient improved dramatically back to 20/20 OS with a completely normal VF over 2 weeks. Because we could not isolate MS as the cause, we ordered bloodwork for other autoimmune and infectious conditions which were also WNL.

She was referred to neurology for further workup for MS such as MRI of the spine and lumbar puncture and testing proved negative. Given that having optic neuritis immediately post-partum is highly suspicious for developing multiple sclerosis, however, she will continue to follow up with neurology.