Eye pain case

Hey, what do you think it is? I was thinking MS or a mild stroke,
here are the facts:
44 year old female
Right eye pain, decreased vision for three weeks
Insidious onset
Pain deep inside the eye
Burning/achey pain
Constant pain
pain getting worse
Blured vision in right eye
Extraoccular muscles in tact (eomi)
No provocative or palliative factors
Tpr 99.2
88 reg rate and rhythm, unlabored =
Bp 118/78
Poor visualization of optic nerve
External ocular motions in tact,
Pupils pearled ( pupil equal and reacted light)
R 20/200 L 20/20
Other cranial nerves within normal limits
Heart Lung Abdomen normal
Dtr’s +2
+5 stregnth
Sensory, mild sporadic loss of light touch in right hand, Non dermatomal
No headaches


Thanks!

[Houman Vosoghi, MD]

I would be very suspicious of high eye pressure in the right eye or glaucoma (narrow angle or a form of open angle could both do this despite the normal pupils).  I would get an ophthalmologist to perform a full exam right away to rule out very high eye pressure and to check for other problems.  It could also be optic neuritis or MS as you stated but the fact that you don't have a good view of the nerve concerns me.  Thorough eye exam required first to rule out the above.  Next step would be MRI with fat suppression and thin cuts through orbits.

HV