BACKGROUND: Optic neuropathy in young patients is a rare clinical finding, usually symptomatic with poor prognosis. In spite of the relatively rare incidence of this clinical etiology, patient''s with early onset optic nerve disfunction are typically easily classified based upon well-established clincal diagnostic criteria. However, this unusual case presentation is that of a young person with an asymptomatic optic neuropathy and unclear etiology and visual prognosis.
CASE REPORT(S). A 16 year-old male presented with a complaint of loss of his "right side" vision for 15 minutes, earlier in the year. The patient could not isolate the symptom to an eye and reported no ocular sequelae. The patient reported no other ocular or medical history. The patient denied pertinent contributing history or events including trauma or childhhood illness. Visual acuity was 20/20 in each eye with a small pupillary defect in the left. Extraocular motility displayed a full range of motion and confrontation fields were full to finger count. Biomicroscopy was without pathology but dilated fundus evaluation revealed asymmetric cup to disc ratios (.55h/.5v OD and .7h/.7v OS) and nerve fiber loss of the superior temporal rim OS . All other fundus findings were without pathology. Humphrey visual field testing was performed with clear field OD but an inferior nasal defect OS corresponding to the optic nerve rim thinning. This defect is thought to be unrelated to the patient's visual complaint of transient field loss. GDx nerve fiber analysis was performed to confirm the findings. Blood work consisted of complete blood count, toxoplasmosis, AC, rapid plasma reagin, and glycosylated hemoglobin which were all normal. An MRI of the brain and orbits showed the left optic nerve is smaller than the right but there was no evidence of any other abnormalities, masses, or enhancement of the optic nerve.
CONCLUSIONS. Management of the case, including suspected etiologic factors, will be included along with clinical images, GDx results, and VF analysis. A summary and differential diagnosis of juvenile optic neuropathy will also be presented.