A Stereotyped Syndrome with Retro-Ocular Pain, Photophobia, and Visual Disturbance Masquerading as Optic Neuritis: Case Series

Abstract

We describe here a case series of six patients referred to the Neuro-ophthalmology service in Sheffield, UK with possible acute unilateral optic neuritis. Each patient had a triad of unilateral photophobia, ipsilateral retro-ocular pain, and ipsilateral loss of vision. All patients had normal ocular examinations and investigation findings with no objective structural or functional abnormalities identified. Patients were treated by weaning-off regular analgesia and, where appropriate, commencing migraine prophylaxis. In the three patients with complete recovery of pain, there was also complete recovery of vision. We propose that this is a migraine syndrome and that the decreased visual acuity is a functional consequence of the pain and photophobia.

The presenting visual symptoms of optic chiasmal disease

“…69 It has occasionally been reported in patients with visual field defects but there are only two published case reports of optic chiasmal compression causing Charles Bonnet syndrome. 70,71 In these cases, the visual hallucinations were perceived across the entire visual field, central visual acuities were reasonable, and the patients were not aware of their bitemporal field defects when they began to experience visual hallucinations. In both cases the visual hallucinations resolved following surgical treatment of the chiasmal compression.…”