Optic neuritis in individuals living with HIV is an uncommon and diagnostically challenging condition. Unlike typical optic neuritis associated with multiple sclerosis, HIV-positive patients require a broader differential diagnosis that includes infectious, inflammatory, and demyelinating processes. This case highlights the crucial role of primary care in the early detection of neuro-ophthalmic emergencies and the importance of coordinated, multidisciplinary evaluationA 52-year-old woman with long-standing HIV infection presented to her primary care physician with a one-week history of right-eye pain, visual discomfort, and progressive visual-field loss. Physical examination revealed a non-reactive right pupil and confirmed visual-field impairment. She was urgently referred to ophthalmology. Investigations included OCT, brain MRI, and pending CSF and serological studies (oligoclonal bands, anti-AQP4, and anti-MOG antibodies). High-dose corticosteroids were administered during hospitalization. Clinical evolution and specialist assessments were documented through dischargeThis case is clinically relevant due to the diagnostic complexity created by HIV infection. MRI showed multiple subcortical lesions, but only one with clear demyelinating features—an ambiguous pattern that sits at the crossroads of several entities: early MS, NMOSD, MOGAD, or HIV-related white-matter changes. The case adds value to the limited literature addressing optic neuritis in HIV-positive individuals and emphasizes the importance of integrating clinical intuition with advanced diagnosticsPrimary care intuition and familiarity with the patient’s history are essential for detecting early neuro-ophthalmic warning signs. HIV infection broadens the differential diagnosis of optic neuritis and requires multidisciplinary evaluation. Timely referral and rapid corticosteroid treatment significantly improve outcomes.The patient exhibited significant clinical improvement following corticosteroid therapy, with visual acuity rising from 0.4 to 0.8 and resolution of retro-ocular pain. This favorable outcome was made possible by the prompt recognition in primary care that the presentation was not benign. The early suspicion of optic nerve pathology triggered rapid referral, timely imaging, and initiation of therapy—crucial factors in preserving optic nerve function.Early identification and coordinated care between primary and specialist services were decisive in ensuring rapid diagnosis and optimal visual recovery. Further evaluation will clarify the underlying demyelinating process and guide long-term management in the context of HIV.