Paraneoplastic and Autoimmune Retinopathy Presenting as Isolated Neuro‐Ophthalmic Dysfunction: Two Cases
Alan B. Dogan, Dean Neutel, Anthony L. LoschnerABSTRACT
Background
Paraneoplastic and autoimmune retinopathies can cause progressive visual loss before structural ophthalmic or neurologic findings are diagnostic.
Case Presentation
A 66‐year‐old woman developed bilateral visual decline and was diagnosed with small‐cell lung cancer‐associated paraneoplastic neuroretinal dysfunction, with persistent blindness despite radiotherapy and plasma exchange. An 81‐year‐old woman with negative malignancy evaluation and abnormal multifocal electroretinography reported visual improvement after intravitreal dexamethasone.
Conclusions
These cases emphasize that nyctalopia, ring scotomas, and photopsias in the context of abnormal electroretinography should prompt retinal evaluation even when structural findings are limited, and that MOG‐ and AQP4‐associated optic neuritis must be explicitly excluded. Early malignancy assessment, immunologic testing, and individualized immunomodulatory treatment are essential; visual recovery is limited once irreversible retinal injury is established.