Which of the following is a possible clinical sign of optic neuritis?

• A. Fixed and dilated pupils
• B. Hyperemic and elevated optic nerve heads
• C. +/- hemorrhages on surface
• D. Blindness

Answer: (D)

Optic neuritis often presents with a sudden, often painful decrease in vision that can be severe enough to be described as blindness. This reduction in visual function reflects inflammation and demyelination of the optic nerve, disrupting signal transmission to the brain. Patients may also have pain with eye movements and a relative afferent pupillary defect, which are common accompanying signs. The optic disc may be swollen in many cases, but the absence of swelling does not exclude optic neuritis. Fixed and dilated pupils are not typical for this condition, and surface hemorrhages are not characteristic findings. So, while other signs can appear, the possibility of substantial, even complete, vision loss makes blindness the best-supported sign in optic neuritis.