Coppens and colleagues reported a case of a 46-year-old male patient with recurrent optic perineuritis after intranasal cocaine abuse.Citation1 Magnetic resonance imaging showed a large soft-tissue mass invading the left orbit from the nasal cavity in this case. A biopsy of the mass demonstrated granulation tissue associated with chronic fibrosing inflammation.
The patient had severe visual loss in his left eye, but had no other symptoms.Citation1 We dissent from the diagnosis of optic perineuritis in the case, since this patient had no eye pain. According to a previous report by Purvin et al., 100% (14/14) of cases with optic perineuritis in their study had eye pain.Citation2 The symptom, eye pain, is an extremely important clue to differentiate between inflammatory and non-inflammatory optic neuropathies.Citation3 The diagnosis of compressive optic neuropathy in this case is suspected because of left crowded orbital apex. We therefore consider the more effective treatment might be surgical management by orbitotomy to remove the solid space-occupying lesion.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References
- Coppens S, Petzold A, de Graaf P, de Vries-Knoppert WAEJ. Recurrent optic perineuritis after intranasal cocaine abuse. Neuro-ophthalmology 2014;38:91–95
- Purvin V, Kawasaki A, Jacobson DM. Optic perineuritis: clinical and radiographic features. Arch Ophthalmol 2001;119:1299–1306
- Rizzo JF 3rd, Lessell S. Optic neuritis and ischemic optic neuropathy. Overlapping clinical profiles. Arch Ophthalmol 1991;109:1668–1672