A 12-year-old presented with sudden, sequential bilateral vision loss over 4 days with no other symptoms. Exams found reduced visual acuity and color vision, sluggish pupils in the right eye, and inferior altitudinal visual field defects in both eyes. MRI and other tests were normal. The patient received IV steroids with mild improvement. Differential diagnoses included post-vaccinial optic neuritis, LHON, infiltrative optic neuropathy, inflammatory conditions like sarcoid, and demyelinating diseases. Further testing like LP would be considered if no improvement with steroids.

1. 12 year old with bilateral
vision loss
Raed Behbehani , MD

2. 12 year old
 A 12 year old with history of sudden,
sequential, bilateral vision loss x 4 days.
 First right eye and 1 day later the left eye.
 No photophobia, or redness.
 No fever, headache or neck pain.
 Otherwise healthy.
 No allergies.

3.  Was admitted to Amiri Hospital .
 CT and MRI brain was normal.
 Received IV steroids x 2 days with mild
improvement in vision.
 CBC , ESR  Normal.
 Ophthalmology consult.

4.  VA : HM , CF 2 meters.
 Color vision : 0/13 OU.
 Pupils : sluggish OU , Right RAPD
 Motility : Full, orthophoric.
 Orbits : Normal RTR.
 TA : 12 mm/Hg OU.
 SLE : Normal anterior segment , no cells
or falre.

5.  Visual field (Confrontation
Inferior altituidinal defects OU + plus dense
central scotomas.

6. Fundus

7. Questions
 What additional information in history you
would like to know ?
 Differential Diagnosis ?
 Investigations ?
 Treatment ?

8. Formulation
 Post-vaccinial optic neuritis.
 LHON , infiltrative optic neuropathy,
inflammatory (sarcoid), dmyelinating
 If no improvement with steroids  LHON
mutation , LP.
 Trial of steroids (no evidence of efficacy).