Atypical optic neuritis related to dental affection: A case report

Background: Optic neuritis may arise from multiple aetiologies, including inflammatory, autoimmune, and infectious causes. Few authors have described a possible link between dental diseases and optic neuritis, although this relationship remains poorly defined due to its rarity. We report a case of unilateral atypical optic neuritis possibly secondary to an approximal caries of the ipsilateral upper jaw. Case presentation: A 43-year-old Caucasian woman with no relevant past medical history presented with unilateral blurred vision, photophobia and ipsilateral temporal headache. Ophtalmic examination revealed anterior optic neuritis in the affected eye. Extensive investigations failed to identified any common underlying aetiology. Neither objective nor subjective change was observed following high-dose intravenous corticosteroids. Remarkably, signs and symptoms resolved spontaneously after extraction of an asymptomatic approximal caries in the ipsilateral maxilla, identified incidentally by a routine dental radiography. While the peripapillary retinal nerve fiber layer remained unchanged during the first two months, optic disc edema gradually improved over the six months following tooth extraction. Conclusions: Dental infection might be a rare and likely underdiagnosed aetiology of idiopathic atypical optic neuritis, and should be considered when no other cause is identified. Although the exact pathophysiology hasn’t been unveiled, several hypotheses have been proposed, warranting further investigation.