Bilateral Retrobulbar HIV Optic Neuritis

The human immunodeficiency virus (HIV) manifests in various ways in the eye. Several optic nerve disorders have been described, most commonly resulting from neoplasms, opportunistic infections, and inflammatory causes [1-4]. HIV itself may be a direct cause of optic neuropathy. It is an uncommon presentation and a diagnosis of exclusion, with only a few cases described in the literature [5-7].PurposeThe purpose of this report is to present a case of bilateral retrobulbar optic neuropathy in an HIV-positive patient without treatment.Case ReportThe authors obtained written consent from the patient for the publication of her anonymised clinical data.A 25-year-old woman presented bilateral visual loss. Past medical history was significant for HIV test in 2008 but no AIDS-defining illness. She declined antiretroviral therapy. Past ocular history was non-contributory, and results from previous eye exams were normal. She developed painful bilateral simultaneous progressive visual loss for the previous 3 months. Her best-corrected visual acuity was 20/200 OD and amaurosis OS. She saw 2/13 Ishihara plates OD and none OS. Visual field was constricted in the OD. The pupils were sluggishly reactive OU. Motility, slit lamp, and retinal exam results were normal. The optic nerves showing bilateral optic disc pallor and atrophic, with more pallor OS than OD (Figures 1, 2). An extensive evaluation for other infectious causes of her visual loss were negative. CD4+ cell count was 20/μL and serum HIV RNA level was 190,000 copies/mL. The full blood count showed leukocytosis (white cell count 13×10˄9 /L) with neutrocytosis (78%).