Paracentral scotoma - left eye - unexplained ?

[LiamAUS]

Hi there, hoping to get some insight from this community. Appreciate any and all advice.

In sum - small fuzzy blind spot about size of coin in upper left eye. 48 hours +

Health - no alcohol, very healthy, no smoking. Wear glasses only for corrective purposes and screens are involved for work.

Presented at emergency and tests run - undilated OCT and slit lamp = nothing abnormal detected. Dilated OCT and slit lamp = nothing abnormal detected. Further OCT while dilated on different machine = nothing abnormal detected. Also undertook CT scan with and without contrast to check if stroke / growths in head / chest / arms can explain. All results normal. Also conducted full blood work - all normal including inflammation markers.

Impression - could be retinal migraine but no headache present.

Next step - MRI on eye socket and further OCT.

Questions - could this be permanent? What medication or supplements could I take to help?

[John C Hagan III, MD, FACS, FAAO]

I don't think this is the direction most people would be directed.  Usual work up might be: see ophthalmologist, dilated exam, amsler grid test, formal visual field test, retinal consult fluoroscene angiogram.  You need a diagnosis before talking about supplements or medications.

[LiamAUS]

Thank so much John! Your reply was so helpful - since your comment I had all of those tests you recommended conducted and the diagnosis is - Acute Idiopathic Blind Spot Enlargement Syndrome. The doctor said I was a 'textbook' case of this, despite being rare.

I am now on tablet steroids.

My questions for you, which I would be so grateful if you considered, are -

1) Prognosis / outlook for this condition? In your experience do these things resolve over time?

2) the doctor was 50/50 on giving me steroids but decided to. In your opinion, is this going to improve my chances of resolving my eye sight back to normal?

[John C Hagan III, MD, FACS, FAAO]

That syndrome is ultra rare, the reference I read said less than 100 cases reported. Since it is being treated with steroids there evidently is some element of inflammation. I can offer no useful information as I've never seen it, never heard of it until now, and don't understand how it differs from optic neuritis variant.

[LiamAUS]

Thanks so much for your reply John, I greatly appreciate it. I have read that Acute Idiopathic Blind Spot Enlargement Syndrome (AIBSE) is similar to Multiple evanescent white dot syndrome (MEWDS). There is debate whether MEWDS leads to AIBSE, for example.

Does this change your reply to my questions 1 and 2 above?

Again, thank you!

[John C Hagan III, MD, FACS, FAAO]

MEWDS is something I am familiar with and have had patients with it.  I don't have time or interest to run down the literature about the similarities.  I have not had a MEWDS syndrome that involved the optic nerve or the macula.