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Case Report Volume 16 Issue 1
Rapid recovery of severe altitudinal visual field defects in a case of acute optic neuritis without significant optic nerve head edema
Len V Koh, Chad E Gosnell, Megan Chandler
Received: January 24, 2026 | Published: February 23, 2026
Citation: Koh LV, Gosnell CE, Chandler M. Rapid recovery of severe altitudinal visual field defects in a case of acute optic neuritis without significant optic nerve head edema. Adv Ophthalmol Vis Syst. 2026;16(1):18-23. DOI: 10.15406/aovs.2026.16.00502
Abstract
Background: Optic neuritis (ON) is an acute inflammatory demyelinating optic neuropathy
that typically presents with subacute, painful vision loss, and an afferent pupillary defect.
Although most cases occur in younger adults and are associated with multiple sclerosis
(MS), ON can present atypically—by age, field pattern, or severity—and overlap with
ischemic and inflammatory mimickers in patient’s ≥50 years old. Altitudinal visual field
defects are classically linked to non‑arteritic anterior ischemic optic neuropathy (NAION),
yet they may occur in ON and can misdirect early management. Rapid, high‑dose
corticosteroid therapy accelerates visual recovery in typical ON, while urgent exclusion
of giant cell arteritis (GCA) and other non‑demyelinating etiologies remains essential in
older adults.
Case report: A 52-year-old Caucasian male presented with sudden blurry and jumping
vision in the upper half of his left eye. Visual acuity was mildly impaired OS, but his visual
field (VF) showed deep superior altitudinal defects. MRI orbits and brain with and without
contrast showed an increased T2 signal and enhancement of the intra-orbital segment of the
left optic nerve, compatible with optic neuritis. Several periventricular and subcortical white
matter FLAIR/T2 hyperintensity. Cerebral spinal fluid chemistry confirmed the presence of
oligoclonal band (IgG) with a high synthesis rate. The patient was referred to neurology
for further management and put on 80 mg/d prednisone with taper schedule. Altitudinal
VF defects were resolved almost completely after a month. Further workup by neurologist
confirmed MS diagnosis and he is being managed by neurologist and rheumatologist.
Conclusion: This case highlights an atypical presentation of ON in a mid‑life patient with a
deep, but transient, superior altitudinal defects. After extensive neurological and laboratory
work ups, MS was the definitive diagnosis. Sudden vision loss and optic neuropathy
require a interprofessional team including internist, optometrist, radiologist, neurologist
and rheumatologist for timely and effective management.
Keywords: optic neuritis, multiple sclerosis, altitudinal visual field defect, MRI, demyelinating disorder
©2026 Koh, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.