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Kang and Kim: Clinical Manifestations of Idiopathic Optic Perineuritis in Korea
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(7): 1016-1022.

Published online: 13 July 2012

DOI: https://doi.org/10.3341/jkos.2012.53.7.1016

Clinical Manifestations of Idiopathic Optic Perineuritis in Korea

Hae Min Kang, MD1, Hye Young Kim, MD2

1Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.

2Department of Ophthalmology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.

Address reprint requests to Hye Young Kim, MD. Department of Ophthalmology, National Health Insurance Corporation Ilsan Hospital, #100 Ilsan-ro, Ilsandong-gu, Goyang 410-719, Korea. Tel: 82-31-900-0590, Fax: 82-31-900-0049, khyeye@hanmail.net

Received 18 April 2011       Accepted 21 May 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To describe the clinical manifestations and magnetic resonance imaging (MRI) characteristics of idiopathic optic perineuritis patients in Korea.

Methods

A retrospective chart review of 5 patients (6 eyes) with idiopathic optic perineuritis and 7 patients (7 eyes) with optic neuritis was performed.

Results

The mean age of the 5 patients with idiopathic optic perineuritis was 59 years, and the mean age of the 7 patients with optic neuritis was 31.1 years. A relative afferent papillary defect (RAPD) was present in 4 eyes with idiopathic optic perineuritis, and in all 7 eyes with optic neuritis. All six eyes with idiopathic optic perineuritis showed relatively severe optic disc swelling, and 6 eyes with optic neuritis showed mild optic disc swelling. MRI demonstrated optic nerve sheath enhancement in all patients with idiopathic optic perineuritis and optic nerve enhancement in six patients with optic neuritis.

Conclusions

On MRI, compared with optic neuritis, idiopathic optic perineuritis had a higher onset age, relatively severe optic disc swelling, and optic nerve sheath enhancement. Because idiopathic optic perineuritis is known to have different treatment strategies and prognosis compared with optic neuritis, differential diagnosis is crucial. The clinical manifestations and MRI characteristics of idiopathic optic perineuritis in the present study will help in the diagnosis of Korean patients.

Keywords: Idiopathic optic perineuritis, Optic neuritis

Figures and Tables

Figure 1
(A) Fundus photography of 66-year-old male patient (Case 4) with idiopathic optic perineuritis shows grade IV optic disc edema in his right eye. He presented with known optic disc edema of 7 weeks in the right eye. (B) Fundus photography after oral steroid treatment.
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Figure 2
Magnetic resonance imaging scan of the orbit with contrast infusion and fat suppression in case 4 with idiopathic optic perineuritis. Axial and coronal view show enhancement of the right optic nerve sheath and streakiness of the surrounding orbital fat.
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Table 1
Clinical manifestations of idiopathic optic perineuritis
jkos-53-1016-i001

VA = visual acuity by Snellen visual acuity chart; VF = visual field; RAPD, relative afferent pupillary defect; MRI = magnetic resonance imaging; ST = superotemporal; LU = log unit; ONS = optic nerve sheath; CF = counting finger; ON = optic nerve; EOM = extraocular muscle.

*This patient experienced idiopathic optic perineuritis in the right eye at first. However, at 5 months after resolution, idiopathic optic perineuritis occurred in the left eye.

Table 2
Clinical manifestations of optic neuritis
jkos-53-1016-i002

VA = visual acuity by Snellen visual acuity chart; VF = visual field; RAPD = relative afferent pupillary defect; MRI = magnetic resonance imaging; LU = log unit; ON = optic nerve; CF = counting finger.

Table 3
Clinical course of optic perineuritis
jkos-53-1016-i003

*This patient experienced monocular idiopathic optic perineuritis at first. However, after 5 months after resolution, idiopathic optic perineuritis occurred in the fellow eye.

Table 4
Features that distinguish optic perineuritis from optic neuritis
jkos-53-1016-i004

RAPD = relative afferent pupillary defect.

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