Optic neuritis (ON) represents inflammation of the optic nerve.
May involve the retrobulbar (retrobulbar neuritis) or the intrabulbar (papillitis) portion of the optic nerve, or both.
Idiopathic ON, the most common form of ON, is an inflammatory optic neuropathy in the absence of evidence of a systemic inflammatory disease.
May occur in isolation or be a manifestation, often the first, of multiple sclerosis (MS).
Investigations including MRI of the brain can help predict the risk of conversion to MS and can dictate early intervention with disease-modifying treatments (interferon-beta, glatiramer acetate) that reduces the risk of conversion to MS.
Acute treatment for idiopathic ON includes intravenous corticosteroid treatment followed by oral prednisone or observation alone.
Oral prednisone alone should not be used in the treatment of idiopathic acute ON.
Papillitis in optic neuritis
From the personal collections of Dr Cris S. Constantinescu and Dr Thomas M. Bosley
- periorbital/retro-ocular pain
- loss of visual acuity with scotoma
- color desaturation/loss of color vision
- relative afferent papillary defect (RAPD)
- optic disk swelling
- neurologic abnormalities of multiple sclerosis
- Uhthoff phenomenon
- Pulfrich phenomenon
- perivenous sheathing
1st Tests To Order
- MRI of the optic nerves
- C-reactive protein
- venereal disease research laboratory (VDRL)
- uric acid
- serum ACE
Other Tests to Consider
- Lyme titer
- B12 and folate
- cerebrospinal fluid analysis
- neuromyelitis optica (NMO) antibody (aquaporin-4 antibody)
- pulsed methylprednisolone
- oral prednisone
- gastrointestinal protection with H2 antagonists or proton pump inhibitors
coexisting inflammatory diseases (e.g., SLE or sarcoidosis)
- immunosuppressive treatment