Optic Neuropathy

[Christine]

I have a history of Optic Neuritis in the left eye.  In two years I have had four attacks.  Each time resulting in a loss of color vision and contrast/detail.  Never did vision return to normal.

I had been diagnosed with MS with 2 clear MRI's and some oligoclonal banding and elevated IGG Index rates in the LP.  Myelin Basic Protein was Normal.  Other unusual and consistent blood reading include elevated/abnormal ANA and ANTI-DNA markers.   Except for VFT on eyes, VFT in rest of body are normal.

My new neurologist wants to re-do the LP.  I began to have symptoms in my "good" right eye that were identical to the symtoms that I had with my first occurence of ON in my left eye nearly 2 years ago:  that is, two weeks of pain on movement followed by vision loss.  My doctor wants to re-do the LP. I have reservations since I feel this is exactly what happened two years ago.

My questions are:  Can ON be just pain?  Is it safe to do an LP if one is in an attack of ON, or will it have no effect?  Is it important to do the LP during an "attack".

Thank you,

christine

[CCF Neuro[P] MD, RPS]

thanks for the comments.

CCF Neuro MD

[GP]

Lyme can cause various eye problems as well as ON. Get tested and read about it - it has, in some cases MS like symptoms, although I'm not sure about LP results. Maybe not Lyme - but worth a look.
Good Luck

[CCF Neuro[P] MD, RPS]

Dear Rose:

Sorry to hear about your eyelid.  There is a special nerve that opens the eye lid, CN III.  Since you do not tell me that once it is open that you have problems keeping it open, then it is not likely to be this nerve.  I would venture to guess that you might have had some tearing that dried up and caused your lid to get stuck.  It would be very, very unlikely to be MS.

Sincerely,

CCF Neuro MD

[rose sweeney]

hi my question is when i go to sleep or get really tired my left eye will not open unless i open it with my finger can you tell me what might cause this i have appointment with a neuroligest in may can this be a sign of ms? please respond to my question  thank you rose

[CCF Neuro[P] MD, RPS]

Dear Christine:

I would ask your physician why he/she wants to do the repeat CSF study.  It sounds like the diagnosis of MS is likely.  Although the MRI is clean thus far, the CSF results together with the symptoms you have had (relapsing and remitting) are fairly diagnostic of MS.  I would approach your physician not in an offensive mode but questions what he/she thinks is going on that another CSF study might help with.

The answer is yes, ON can be an isolated occurance.  Oligoclonal banding can arise from many other types of illness other than MS.  However, we do know that ON is the most common presenting factor in MS, but only occurs in 35 - 45% of MS patients as the initial presenting sign.  So, maybe you physician thinks that there is something else as the initiator of your ON.  I would just sit down and talk.

Sincerely,

CCF Neuro MD