Optic perineuritis - Clinical and radiographic features

Background: Optic perineuritis is an uncommon variety of orbital inflammato ry disease that is distinct from demyelinating optic neuritis. Objective: To describe the clinical and radiographic features of idiopathic optic perineuritis, with particular emphasis on those features that help t o distinguish this condition from optic neuritis. Methods: We reviewed the medical records of 14 patients with optic perineur itis who were seen in 2 neuroophthalmology clinics. Results: Patients ranged in age from 24 to 60 years; 5 were older than 50 y ears. All patients had visual loss, eye pain, or both. The visual acuity wa s 20/20 or better in 8 of the 15 eyes. The results of visual field testing were normal in 2 eyes, and a paracentral scotoma or an arcuate defect was s een in 7, Magnetic resonance imaging scans demonstrated circumferential enh ancement around the optic nerve, sometimes with intraorbital extension. Res ponse to corticosteroids was dramatic, however, 4 patients had a relapse wi th lowering of the dose. Conclusions: In contrast to those with optic neuritis, patients with optic perineuritis are often older at onset and are more likely to show sparing o f central vision. Magnetic resonance imaging scans demonstrate enhancement around, rather than within, the optic nerve. Response to corticosteroids is more dramatic than in patients with optic neuritis, and patients are more likely to experience recurrence after stopping treatment.