Misdiagnosis of Optic Neuritis Leading to Blindness

Case Overview

This case study involves a 46-year-old male who sought medical attention at an urgent care facility due to symptoms of eye pain, red conjunctiva, and vision loss. Despite conservative treatment and advice to consult an ophthalmologist if symptoms persisted, the patient's condition did not improve. In addition to the diagnosis of conjunctivitis by the primary care provider, a subsequent eye examination by an optometrist revealed no significant findings.

As the patient's symptoms worsened, they were eventually diagnosed with optic neuritis, which unfortunately caused blindness. An ophthalmologist is asked to discuss causation and whether the standard of care was followed during the patient's care.

Questions to the Ophthalmology expert and their responses

How often do you treat and evaluate optic neuritis patients?

As an experienced ophthalmologist who has spent several years supervising both an eye hospital emergency department and a university-affiliated emergency referral clinic, I frequently encounter patients with optic neuritis as it is a common diagnosis in my field.

Based on your experience, what diagnostic hallmarks of this condition would warrant urgent intervention to optimize patient outcomes?

Optic neuritis is typically easy for an ophthalmologist to diagnose based on a hallmark pupil exam finding known as an afferent pupillary defect. While I wouldn't expect an urgent care provider, primary care physician, or optometrist to have the knowledge or skills to make this diagnosis, given the presence of pain and vision loss, this should have triggered an emergent referral for higher-level care.

Have you ever reviewed a similar case? If yes, please elaborate.

Yes, however, I am particularly interested in reviewing this case because optic neuritis in males is rare. I am keen to understand the presentation and diagnostic tests conducted.

About the expert

This expert is a highly experienced ophthalmologist with over a decade of experience. They have completed extensive training, including two residencies in internal medicine and ophthalmology at reputable institutions, and are board certified in ophthalmology. Currently, they hold significant positions as a clinical instructor in ophthalmology at a prestigious eye institute, and as an adjunct assistant professor at an Ivy League university. They also serve as the division head of ophthalmology at a university-affiliated medical center. Their vast experience and current roles underscore their expertise and relevance in this case.