This paper reports two cases of unilateral painless vision loss. Case 1 involved a 47-year-old male presenting with subacute vision loss in the right eye, accompanied by optic disc edema and macular stellate exudates. Serological testing revealed positive IgG antibodies against Bartonella henselae (titer 1:256). Combined with a history of cat contact and flea bites, a diagnosis of cat scratch disease-associated optic neuroretinitis was made. After treatment with oral doxycycline combined with periocular triamcinolone acetonide injection, the patient's vision significantly improved to 1.0. Case 2 involved a 33-year-old male presenting with acute visual field defect in the right eye accompanied by mild vision loss, optic disc edema with hemorrhage, and cotton-wool spots. Serological tests showed positive IgG antibodies against Bartonella henselae (titer 1:256) and positive antibodies against Treponema pallidum (TPPA+, TRUST+). Initial empirical treatment for cat scratch disease (doxycycline + rifampicin) and syphilis (benzathine penicillin) was ineffective, with continued vision decline. Optical coherence tomography (OCT) at the one-month follow-up revealed focal spiculated protrusions of the retinal pigment epithelium (RPE) around the optic disc, consistent with characteristic ocular changes of syphilis. Considering the patient's poor response to anti-Bartonella henselae treatment, the diagnosis was revised to syphlitic optic neuropathy. After continued anti-syphilis treatment, the patient's vision stabilized at 0.63, but optic atrophy persisted. These two cases suggest that the diagnosis of infectious optic neuropathy requires comprehensive differentiation based on medical history, clinical manifestations, auxiliary examinations, treatment responses, and characteristic signs, with particular caution in interpreting positive serological results for Bartonella henselae antibodies.
