Re: Optic nerve problem

Posted By CCF NEURO MD on July 31, 1997 at 17:19:41:

In Reply to: Optic nerve problem posted by LTK on July 29, 1997 at 19:26:47:







: I am being treated for "probable MS". I wrote a while back asking about migraines
that I was having. I had 24 in the course of about 5 months, & they seem to have
stopped. I am now noticing a vision problem. I am very nearsighted, wear contacts,
& my vision has not changed since 1974. Around halfway through the migraines, I began
to feel that, sometimes, I had my lenses in the wrong eye...my left eye just didn't
want to focus properly. My present neurologist sent me to a neurologist at U of
Michigan (mainly for another opinion on the migraines I'd been having), & she is the
one who noticed that my left pupil was not reacting to light correctly. She suggested
I see an ophthalmologist, which I did. Visual Field tests came back alright, eye
pressure was ok, & while the doctor didn't see evidence of "classic optic neuritis",
he did say that, when switching a penlight from one eye to another & back again,
the pupil of the left eye reacted abnormally. I am going back in a couple weeks for
a regular vision test, but in the meantime, I am curious about this problem
with my left optic nerve. I realize I haven't given you a lot of details, but that
is all I was told. Pardon the pun, but could you shed any "light" on what could be
causing this problem? And, what if anything, can be done about it?
Thanks for providing this service....I think it's wonderful!



  


Interesting case. Optic neuritis may be the initial presenting sign for multiple sclerosis.
The "abnormality" you talk about with the left pupil not responding to light could be a
result of ON and is called an APD or afferent pupillary defect. On a dilated eye exam your
eye doctor should be able to see evidence of optic pallor. You could also have a
visual evoked potential done to look for ON. While not all patients that develop ON
go on to develop MS the majority do and a MRI scan is usually done looking for evidence of
CNS demyelination. Most people would recommend treating ON with IV steroids not oral steroids.
People with ON often complain of objects not looking crisp and may not see the color red as well in
the affected eye. Other work-up for MS could be a lumbar puncture. At CCF we have
the Mellen centre which deals with patients who have MS. It sounds like you
need some more information from your doctors regarding what they think is going on and
what if any treatment you need. As an aside, you can also have visual problems from migraine even
without a headache so it sounds like some more work needs to be done. I hope this
spreads alittle "light" on your problem.
Remember, this advise is for information purposes only and you need to F'U with your local medical
doctor for more information.