Severe Eye Pain in MOGAD
Yes, severe eye pain is a characteristic presenting symptom in MOGAD, particularly during acute optic neuritis episodes, and glucocorticoid treatment provides significant pain relief. 1
Pain Characteristics in MOGAD Optic Neuritis
Retrobulbar pain is a common feature of MOG-antibody-associated optic neuritis, often accompanying the visual symptoms at presentation. 2 The pain typically:
- Occurs with eye movement (retrobulbar pain pattern) 2
- Can be severe enough to be a prominent presenting complaint alongside visual loss 3, 1
- Responds dramatically to intravenous methylprednisolone pulse therapy, with pain alleviation or significant relief occurring rapidly after glucocorticoid administration 1
Clinical Context of Pain Presentation
The eye pain in MOGAD occurs in the setting of:
- Severe visual deficit or blindness during acute episodes, often bilateral 4, 5
- Prominent papilledema, papillitis, or optic disc swelling on fundoscopy (76.2% of affected eyes show optic disc edema) 4, 1
- Perioptic gadolinium enhancement on MRI during acute optic neuritis 4
- Longitudinally extensive optic nerve lesions (74.6% show long-segment disease on MRI) 1
Distinguishing Features from Other Causes
MOGAD-associated optic neuritis can initially mimic pseudotumor cerebri when presenting with bilateral disc swelling and pain in the early stages, potentially delaying appropriate treatment. 6 Key distinguishing features include:
- Rapid onset of severe visual loss (58.7% present with severe visual loss) 1
- Bilateral simultaneous involvement is common 1
- Optic perineuritis occurs in 47.6% of cases 1
- Red color desaturation is a typical finding 2
Critical Treatment Implications
Timely recognition and treatment of the pain syndrome is essential because:
- Delayed immunosuppressive treatment may cause irreversible optic nerve damage 2
- High-dose intravenous methylprednisolone is first-line therapy and provides rapid pain relief 7, 8, 1
- Slow steroid taper is mandatory due to high risk of flare-ups after rapid cessation 7, 8
- Plasma exchange or immunoadsorption should be initiated early if steroids fail 7, 8
Common Pitfall
Do not misdiagnose early MOGAD optic neuritis as pseudotumor cerebri based solely on bilateral disc swelling and headache/eye pain, as this delays critical immunosuppressive therapy. 6 The presence of rapid visual loss, retrobulbar pain with eye movement, and red color desaturation should prompt immediate consideration of MOG-antibody testing with cell-based assays. 2, 6