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Letters to the Editor

Atypical optic neuritis due to tuberculosis

Venugopal, Nataraja Pillai

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Indian Journal of Ophthalmology: July 2015 - Volume 63 - Issue 7 - p 623
doi: 10.4103/0301-4738.167110
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We read with interest the article titled “A case of subretinal tubercular abscess presenting as disc edema” by Shetty et al.[1] Authors have mentioned about the difficulty to decide whether the first episode of defective vision is due to demyelinating optic neuritis (DON) or atypical optic neuritis (AON). Asian race, pain persistent for >2 weeks from the onset of defective vision and worsening of vision for >2 weeks are a feature of AON.[2] In Shetty et al.[1] case report, an Asian patient, had pain persisting for 25 days and gradually progressive loss of vision in left eye since 20 days. The disc swelling of DON is diffuse and the presence of segmental changes, altitudinal swelling, pallor, arterial attenuation, and splinter hemorrhages should bring its diagnosis into question. In Shetty et al. case report the disc edema is pronounced and elevated in the upper temporal quadrant.

In DON, the disc is normal in 65% of patients (retrobulbar neuritis).[3] If disc edema is present in DON, it is mild and diffuse. To conclude, from above-mentioned features the first episode of defective vision may be due to tuberculous AON.

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1. Shetty SB, Bawtag MA, Biswas J. A case of subretinal tubercular abscess presenting as disc edema Indian J Ophthalmol. 2015;63:164–6
2. Shams PN, Plant GT. Optic neuritis: A review Int MS J. 2009;16:82–9
3. Behbehani R. Clinical approach to optic neuropathies Clin Ophthalmol. 2007;1:233–46
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