The optic disc is swollen. If vision were normal, this appearance could be due to papilloedema secondary to raised intracranial pressure (but not due to hypertension in the absence of any retinal haemorrhages or cotton wool spots). However, vision is impaired, making optic disc swelling secondary to an acute optic neuropathy the correct diagnosis.
The commonest cause of acute optic neuropathy in a young woman is multiple sclerosis. It will be important to pursue this possibility in the history:
▪ has this ever happened before?
▪ have you ever had problems with your arms / legs / walking / balance before?
▪ have you ever seen a neurologist about any problems before?
Aside from fundoscopy, key issues to check on examination of the eye are:
▪ visual acuity
▪ presence of a central scotoma
▪ impaired colour appreciation so that, compared with the normal eye, colours look washed out
▪ a relative afferent pupillary defect.
A full neurological examination to look for evidence of deficit elsewhere will be appropriate.
The eventual level of recovery of visual acuity is difficult to predict, hence a guarded prognosis must be given. Deciding whether or not to engage the patient in discussion about multiple sclerosis and/or further tests to pursue this diagnosis requires careful consideration.
Reference
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