A case of chronic relapsing inflammatory optic neuropathy (crion)

Purpose The chronic relapsing inflammatory optic neuropathy (CRION) is a recurrent optic neuropathy not associated with any demyelinating or systemic desease, characterized by the need for prolonged immunosuppressive therapy to prevent relapse. Methods We report the case of a 32 year old man who presented three episodes of optic neuritis in the left eye over a period of 8 months. Each episode remitted quickly with intravenous steroids and resorted after gradual withdrawal thereof. The initial visual acuity in left eye was counting fingers, had relative afferent pupillary defect and diffuse edema of the optic nerve. All systemic examinations were normal (analytics, and serology tests, imaging studies, lupus anticoagulant, ECA and autoimmunity tests). Results After CRION suspected, corticosteroid treatment was decided at a dose of 1mg/kg/day maintained in decreasing doses associated with azathioprine, and response to treatment was favorable, with no new episodes. Actually, visual acuity is 7/10 , there are palidness optic disc and inferior visual field lost in perimetry due to optic neuritis. Conclusion CRION is a recurrent optic neuritis, corticoid dependent, not associated with any neurological deficit or autoimmune disease. Severe visual loss, associated with persistence of pain after onset of visual loss and frequent recurrences should make us suspect this entity.