• Optic Neuritis

    (Inflammation of Optic Nerve)

    Definition

    The optic nerve allows you to see by carrying images from your eye to your brain. Optic neuritis involves swelling of the optic nerve. This may cause reduced vision or loss of vision. It is a serious condition that requires immediate care from your doctor.
    The Optic Nerve
    Nucleus Image
    Copyright © Nucleus Medical Media, Inc.

    Causes

    The cause of optic neuritis is often unknown. Known causes of the diseases include:
      An attack on the optic nerve by a viral infection or by the body's own immune system—This may be associated with autoimmune disorders, such as:
    • Exposure to toxic substances. This can be associated with optic neuropathy (injury to the optic nerve).
    • Some medicines

    Risk Factors

    Risk factors that increase your chanced of developing optic neuritis include:
    • Personal or family history of multiple sclerosis or other autoimmune disorders—Autoimmune diseases are more common in women of child-bearing age.
    • Previous history of optic neuritis
    • Previous history of transverse myelitis (inflammation of the spinal cord)

    Symptoms

    Symptoms of optic neuritis include:
    • Sudden decrease in vision—blurred, dark, or dim vision, or loss of vision in the center of, part of, or all of the visual field. In mild cases, it may look like “the lights are turned down.”
    • Abnormal color vision (dull and faded colors)
    • Pain in or around the eye (often made worse with eye movement)
    Eye pain will often go away within a few days. Vision problems will improve in over 90% of patients. Some patients may be left with blurred, dark, dim, distorted vision, or complete visual loss. Vision usually improves over several weeks or months.

    Diagnosis

    Optic neuritis may be difficult to diagnose. Your eye may look perfectly normal. Your doctor will ask about your symptoms and medical history. A physical exam will be done. It will include a neurologic examination. You may be referred to an ophthalmologist (eye specialist) or neurologist (brain and nervous system specialist).
    Your doctor may need to test your eye function. This can be done with:
    • Tests of color vision, side vision, visual acuity, and the reaction of the pupil to light
    • Dilated eye examination
    • Visual evoked potential test
    • Optical coherence tomography (OCT)
    Your doctor may need to test your body fluids. This can be done with:
    Your doctor may need pictures of your body structures. This can be done with an MRI scan
    Your doctor may also need to evaluate you for spinal cord problems. This can be done with a somatosensory evoked potentials test.

    Treatment

    Talk with your doctor about the best treatment plan for you. Treatment options include:
    • Steroid medicine to reduce swelling of the optic nerve
    • Medicine to treat the cause of optic neuritis

    Prevention

    There is no known way to prevent optic neuritis the first time it happens. The chance of having it again may be reduced if the first episode is treated with a steroid or other medicine. It is important to see a doctor right away if you develop pain or decreased vision.

    RESOURCES

    American Academy of Opthalmology http://www.aao.org/

    North American Neuro-Ophthalmology Society http://www.nanosweb.org/

    CANADIAN RESOURCES

    Canadian Association of Optometrists http://www.opto.ca/

    Canadian Ophthalmological Society http://www.eyesite.ca/

    References

    Agostoni E, Frigerio R, Protti A. Controversies in optic neuritis pain diagnosis. Neurol Sci . 2005;26(Suppl 2):s75-s78.

    Bianchi Marzoli S, Martinelli V. Optic neuritis: differential diagnosis. Neurol Sci . 2001;22(Suppl 2):S52-S54.

    Boomer JA, Siatkowski RM. Optic neuritis in adults and children. Semin Ophthalmol . 2003;18:174-180.

    Chan JW. Optic neuritis in multiple sclerosis. Ocul Immunol Inflamm . 2002;10:161-186.

    Hickman SJ, Dalton CM, Miller DH, Plant GT. Management of acute optic neuritis. Lancet . 2002;360:1953-1962.

    Lis SY, Birnbaum AD, Goldstein DA. Optic neuritis associated with adalimumab in the treatment of uveitis. Ocul Immunol Inflamm . 2010;18(6):475-481.

    Optic neuritis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 30, 2011. Accessed November 27, 2012.

    Romero RS, Gutierrez Y, Wang E, Reder AT, Bhatti MT, Bernard JT, Javed A. Homonymous hemimacular thinning: a unique presentation of optic tract thinning in neuromyelitis optica. J Neuroophthalmal. 2012;32(2):150-3.

    Volpe NJ. The optic neuritis treatment trial: a definitive answer and profound impact with unexpected results. Arch Ophthalmol . 2008;126(7):996-999.

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