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Visual Loss in a Young Man
  1. Ian McDonald
  1. Emeritus Professor of Clinical Neurology, Institute of Neurology, Queen Square, London WC1N 3BG; E-mail: m.whale{at}



A 29-year-old man presented in the winter of 1973/4 to the Emergency Department of the Moorfields Eye Hospital, London, complaining of painless and increasing blurring of monocular vision over several days. He was referred to the physician’s clinic where he was seen two weeks later. There had been no improvement. There was moderately severe (6/24) impairment of left eye vision with a central scotoma and a relative afferent pupillary defect. The fundi were normal. A diagnosis of acute optic neuritis was made, the only slightly unusual feature being the absence of pain on eye movement; but this is so in about 20% of cases. A plain X-ray of the skull was normal. ACT scan (the availability of which was very restricted at that time) was not performed.

At follow up a month later vision had returned virtually to normal, in keeping with the diagnosis of optic neuritis. The

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