A patient with signs and symptoms suggestive of optic neuritis should be investigated for an alternative diagnosis if certain findings are present.
Findings indicating an alternative diagnosis to optic neuritis:
(1) optic atrophy on presentation, without previous optic neuritis or multiple sclerosis
(2) severe optic disc edema with vitreous reaction
(3) optic disc hemorrhage
(4) bilateral loss of vision
(5) a previous history of a neoplastic disease
(6) African or Afro-Caribbean patient with vision < 6/12 and no early recovery (sarcoidosis)
(7) loss of vision with no perception of light and with no early recovery
(8) painless loss of vision to < 6/60 and no early recovery
(9) severe or persistent pain for more than 2 weeks after onset
(10) visual loss progressing more than 2 weeks after the onset of visual symptoms
(11) absence of recovery more than 3 weeks after the onset of visual symptoms
(12) deterioration of vision after withdrawal of corticosteroids (corticosteroid-responsive optic neuropathy)
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Specialty: Ophthalmology, Neurology