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NEUROSAE 2018 ANNUAL MEETING EDITION (VOLUME 10, ISSUE 3)
QUESTION 45 OF 100
A 19-year-old man presents with a sudden painful loss of vision in the left eye that is worse with movement. Examination reveals an afferent pupillary defect involving the left eye. The pictograph shown is representative of his fundoscopic examination. Results of additional workup, including MRI of the brain and lumbar puncture, are normal. Which of the following is the most appropriate next step in management?
A. Initiation of prednisone 60 mg with a taper
B. Administration of IV rituximab
C. Administration of IV methylprednisolone **
D. Observation and follow up examination
E. Referral for fluorescein angiography
** = Your answer
The patient has optic neuritis and should be treated with IV methylprednisolone. The Optic Neuritis Treatment Trial demonstrated that oral prednisone increases the risk of both recurrent optic neuritis and the development of multiple sclerosis. Rituximab is not indicated in the treatment of optic neuritis. Given the presentation of painful vision loss, non-arteritic ischemic optic neuropathy is less likely; therefore, angiography is not indicated.
* Beck RW, Gal RL. Treatment of acute optic neuritis: a summary of findings from the optic neuritis treatment trial. Arch Ophthalmol. 2008 Jul;126(7):994-995.