Bilateral sequential optic neuropathy as the initial manifestation of Sjogren syndrome.

Author(s): Pournaras JA, Vaudaux JD, Borruat FX

Affiliation(s): Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland.

Publication date & source: 2007-04, Klin Monatsbl Augenheilkd., 224(4):337-9.

Publication type: Case Reports

BACKGROUND: Neuro-ophthalmic findings are uncommon in the setting of Sjogren syndrome. We report the case of a patient with bilateral, sequential optic neuropathy as the initial manifestation of Sjogren syndrome. HISTORY AND SIGNS: A 38-year-old male presented with sudden painless visual loss in his left eye in May 2005. Fundus examination revealed a left swollen optic disk. Magnetic resonance imaging (MRI) revealed a left optic nerve lesion. Elevated titres of autoantibodies (ANA, anti-SSA, anti-SSB) were found, suggestive of Sjogren syndrome. In January 2006, he presented with painful sudden visual loss in the right eye. Fundus examination revealed a right swollen optic disk and left optic nerve atrophy. MRI was normal. Other aetiologies were ruled out. THERAPY AND OUTCOME: Each episode was treated with intravenous methylprednisolone (1 g/day during 3 days), followed by oral prednisone (1 mg/kg/day). Moderate improvement of vision ensued in both eyes. CONCLUSIONS: Atypical presentation of an optic neuropathy must raise the suspicion of an unusual aetiology. Our case illustrates how a bilateral sequential optic neuropathy in an otherwise healthy patient can result from an unusual inflammatory aetiology: primary Sjogren syndrome.