Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute, unilateral vision loss accompanied by retro-orbital pain exacerbated by extraocular movements. Onset is subacute over several days. Reports dyschromatopsia (specifically red desaturation) and photopsias. No history of trauma or prior ocular surgery.
Clinical Examination Findings
Visual acuity reduced in affected eye. Relative Afferent Pupillary Defect (RAPD) present. Color vision testing (Ishihara) shows significant deficit. Funduscopy reveals optic disc edema (papillitis) or normal appearance (retrobulbar neuritis). Visual field testing demonstrates central scotoma.
Treatment Protocol
Initiate high-dose intravenous corticosteroid therapy (e.g., Methylprednisolone) followed by an oral taper, depending on clinical severity and MRI findings. Monitor for systemic side effects. Urgent neurology consultation for demyelinating disease workup, including MRI of the brain and orbits with gadolinium contrast.