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Optic neuritis
OVERVIEW: Inflammation of the optic nerve
System(s) affected: Nervous
Genetics: N/A
Incidence/Prevalence in USA: N/A
Predominant age: Typically 18-50 years
Predominant sex: Female > Male
SIGNS AND SYMPTOMS: • Loss of vision, deteriorating from hours to days, usually reaching lowest level in one week
• Usually unilateral in adults, bilateral disease more common in children
• Tenderness of the globe, deep orbital pain or brow ache, especially with eye movement
• Central, cecocentral or arcuate visual field deficits
• Decreased color vision
• Apparent dimness of light intensities
• Impairment of depth perception
• Increase in visual symptoms with increased body temperature (Uhthoff's sign)
• May be either swollen optic disk (most commonly seen in children) or normal optic disc
• Relative afferent pupillary defect (Marcus Gunn pupil)
CAUSES: • Idiopathic
• Multiple sclerosis
• Viral infections of childhood (measles, mumps, chickenpox)
• Other viral infections (mononucleosis, herpes zoster, encephalitis)
• Contiguous inflammation of the meninges, orbit, or sinuses
• Granulomatous inflammations (syphilis, tuberculosis, cryptococcus, sarcoidosis)
• Intraocular inflammations
• Lead toxicity
• Chronic high doses chloramphenicol
• Posterior uveitis
• Vascular lesions of optic nerve
• Tumors
• Fungal infections
RISK FACTORS: N/A
DIAGNOSIS DIFFERENTIAL DIAGNOSIS: • Acute papilledema
• Anterior ischemic optic neuropathy
• Severe systemic hypertension
• Toxic/nutritional optic neuropathy
• Orbital tumor compressing the optic nerve
• Intracranial tumor pressing on the afferent visual pathway
• Leber's congenital optic neuropathy
LABORATORY: • CBC
• Antinuclear antibody (ANA)
• ESR
• Rapid plasma reagin (RPR)
• Fluorescent treponemal antibody absorption (FTA-ABS)
• Serological test for syphilis
Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A
PATHOLOGICAL FINDINGS: N/A
SPECIAL TESTS: • Visual field test (preferably automated Humphrey or Octopus)
• Color vision testing
IMAGING: • Chest x-ray
• MRI head or CT head/orbits in atypical cases or when patient is not improving after 10-14 days and other tests are negative
DIAGNOSTIC PROCEDURES: • Check blood pressure
• Complete ophthalmologic exam including pupillary assessment, color vision evaluation with color plates, dilated retinal examination with optic nerve assessment
• Neurologic work-up
TREATMENT APPROPRIATE HEALTH CARE: Outpatient observation
GENERAL MEASURES: No disease specific measures
SURGICAL MEASURES: N/A
ACTIVITY: Fully active
DIET: No special diet
PATIENT EDUCATION: • Reassurance about recovery of vision
• If felt to be secondary to demyelinating disease, patient should be informed of the risk of developing multiple sclerosis
• For patient education materials favorably reviewed on this topic, contact: National Eye Institute, Information Officer, Dept. of Health and Human Services, 9000 Rockville Pike, Bethesda, MD 20892, (301)496-5248
MEDICATIONS DRUG(S) OF CHOICE: None
Contraindications: N/A
Precautions: N/A
Significant possible interactions: N/A
ALTERNATIVE DRUGS: • Pulse steroids: methylprednisolone 250 mg IV q6h x 12 doses in the hospital followed by prednisone 1 mg/kg/day po for 11 days, taper over 1-2 weeks
• Anti-ulcer medication is given with steroids
FOLLOW UP PATIENT MONITORING: Monthly followup to monitor visual changes
PREVENTION/AVOIDANCE: N/A
POSSIBLE COMPLICATIONS: Permanent loss of vision
EXPECTED COURSE AND PROGNOSIS: • Visual acuity begins to improve 2-3 weeks after onset
• Improvement continues over several months and vision often returns to normal or near normal levels
• Those patients with poor vision and who receive IV steroids often recover faster
• When baseline vision is good, IV steroids have no beneficial effect
MISCELLANEOUS ASSOCIATED CONDITIONS: Over 50% of adult optic neuritis patients will develop multiple sclerosis
AGE-RELATED FACTORS:
Pediatric: N/A
Geriatric: N/A
Others: N/A
PREGNANCY: N/A
SYNONYMS: • Papillitis
• Retrobulbar neuritis
ICD-9-CM: 377.30 Optic neuritis
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