Unexplained Optic Neuritis
The evaluation and management of isolated and unexplained optic atrophy is a relatively common, but difficult, clinical problem for a comprehensive ophthalmologist. Although, in most cases, the history and examination are sufficient to determine the etiology, some patients are left without a diagnosis at the end of the initial ophthalmology encounter. Multiple factors contribute to the clinical problem including: patients may present with physiologic pallor of the disc without other evidence for a true optic neuropathy; patients may be asymptomatic despite an optic neuropathy clinically; patients may report an acute onset of symptoms that is due to acute awareness of their visual loss; and the fundus signs of a previous event (i.e., a “footprint” of the etiology) may be subtle or nonspecific, especially when the patient is seen months or years after the acute episode.
