Case Report: Optic Nerve Atrophy Secondary to Sjogren Syndrome

SIGNIFICANCE Optic neuropathy associated with Sjogren syndrome is rare and usually has an acute onset. PURPOSE This study aimed to report a case of asymmetric optic nerve atrophy attributed to Sjogren syndrome. CASE REPORT A 37-year-old woman was referred to neuro-ophthalmology service because of right optic nerve atrophy of unknown etiology. The patient was asymptomatic. Best-corrected visual acuity was 20/200 Snellen equivalent in the right eye and 20/20 Snellen equivalent in the left eye. The right eye had a relative afferent pupillary defect. Visual field demonstrated dense temporal loss, superior arcuate involvement, and an inferior paracentral defect in the right eye. Slit-lamp examination showed mild fluorescein staining of the cornea, moderate lissamine green staining of the conjunctiva, and abnormal tear breakup time in both eyes. Fundus examination revealed diffuse pallor of the right optic disc and a normal left optic disc. Optical coherence tomography showed inferior and superior retinal nerve fiber layer atrophy in the right eye and inferior retinal nerve fiber layer atrophy in the left eye. A diagnosis of right optic nerve atrophy was made. Immunologic studies were significant for positive anti-Ro and anti-La antibodies. MRI of the brain and orbit ruled out any intracranial or white-matter pathology. A diagnosis of optic nerve atrophy secondary to Sjogren syndrome was suspected, so corticosteroid treatment was started. CONCLUSIONS Optic nerve atrophy may be the initial manifestation of Sjogren syndrome. Therefore, optic neuropathy associated with Sjogren syndrome remains a diagnostic challenge. In these cases, specific antibodies such as anti-Ro and anti-La facilitate early diagnosis and can prevent vision-threatening complications.