Presumed glaucoma was actually a steroid-dependent optic nerve inflammation
A woman's years of eye pain and vision loss were labeled migraine, then glaucoma, until the pattern of damage pointed to an inflamed optic nerve.
A woman in her 40s had years of recurrent pain behind the eye, first attributed to migraine and later to glaucoma from suspected intermittent angle closure. Pressure-lowering drops controlled her intraocular pressure, yet her vision kept getting worse.
Several features did not fit glaucoma: a markedly pale optic disc, rapid progression despite controlled pressure, and diffuse rather than sectorial nerve fibre layer thinning. Visual evoked potentials showed delayed conduction, and MRI revealed inflammatory changes in the optic nerve. The diagnosis became chronic relapsing inflammatory optic neuropathy.
High-dose corticosteroids brought marked improvement, but symptoms returned when they were withdrawn. Immunosuppressive therapy was then started, with sustained visual recovery.
This is a single case report, so it cannot show how often such misdiagnosis occurs. It illustrates how atypical features can signal a different disease.
Summary prepared with AI assistance from the published abstract and reviewed by a physician. Not medical advice. Learn more
