optic nerve temporal pallor

[hello07]

healthy female in late 40's. No meds. correctable to 20/20 each eye and both eyes. complete eye exam normal. R optic nerve showed temporal pallor mild maybe to moderate. L optic nerve pink and healthy. She has no symptoms. feels fine.
Is this usually normal in most cases OR can anything be going on systemically?
Thank you for any input.

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[Andrew_Doan]

healthy female in late 40's. No meds. correctable to 20/20 each eye and both eyes. complete eye exam normal. R optic nerve showed temporal pallor mild maybe to moderate. L optic nerve pink and healthy. She has no symptoms. feels fine.
Is this usually normal in most cases OR can anything be going on systemically?
Thank you for any input.

We tend not to give medical advice on this forum. Hypothetically speaking, however:

A case of true optic nerve pallor should be associated with VF loss and RAPD in the eye, as well as possible color vision loss.

Optic nerve pallor and vision loss in a 40 y.o. should be followed-up with a MRI scan of the optic nerves and orbits. This patient should be referred to an ophthalmologist for the appropriate tests and examinations.

 

[hello07]

thank you Doc.

 

[orbitsurgMD]

healthy female in late 40's. No meds. correctable to 20/20 each eye and both eyes. complete eye exam normal. R optic nerve showed temporal pallor mild maybe to moderate. L optic nerve pink and healthy. She has no symptoms. feels fine.
Is this usually normal in most cases OR can anything be going on systemically?
Thank you for any input.

You might try the pupil testing in different ambient lighting and with different stimuli. A discriminating color vision test that defines acquired deficiencies helps, like the SPP-2 album. You should also perform perimetry. A Humphrey 24-2 SITA fast should do. Consider documenting the findings with photos, if you have that capability.

If there are deficiencies, then imaging by MR with gadolinium contrast is indicated.

If you cannot do these tests, refer the patient to a neuro-ophthalmologist.

 

[DBOD]

Please give me an idea of the urgency with which this sort of case should be referred to neuro-ophth.

thank you.

 

[orbitsurgMD]

Please give me an idea of the urgency with which this sort of case should be referred to neuro-ophth.

thank you.

If you cannot perform the workup yourself immediately, then you should refer immediately.