irAE Optic Neuritis — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyirAE Optic NeuritisSCE Medical Oncology

A 60-year-old man on nivolumab for RCC develops painless visual field loss in the right eye. Fundoscopy reveals disc swelling and cotton-wool spots. ESR is normal. What immune-related adverse event should be suspected?

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Correct answer: C — Immune-related optic neuritis/papillitis

Immune-related optic neuritis/papillitis is a rare but sight-threatening irAE characterised by disc swelling, visual field defects and reduced acuity. Normal ESR helps exclude giant cell arteritis. Management requires urgent ophthalmology referral, ICI discontinuation, and high-dose IV methylprednisolone (1 g/day for 3-5 days) followed by oral prednisolone taper. MRI orbits should be performed to assess optic nerve enhancement. Visual recovery is variable and early treatment is critical.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer