Optic Neuritis. In: Papadakis MA, McPhee SJ, Bernstein J. Papadakis M.A., & McPhee S.J., & Bernstein J(Eds.),Eds. Maxine A. Papadakis, et al.eds. Quick Medical Diagnosis & Treatment 2022. McGraw Hill; 2022. Accessed January 18, 2022. https://accessmedicine.mhmedical.com/content.aspx?bookid=3109&sectionid=261308335
Optic neuritis. Papadakis MA, McPhee SJ, Bernstein J. Papadakis M.A., & McPhee S.J., & Bernstein J(Eds.),Eds. Maxine A. Papadakis, et al. (2022). Quick Medical Diagnosis & Treatment 2022. McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=3109&sectionid=261308335
"Optic Neuritis." Quick Medical Diagnosis & Treatment 2022 Papadakis MA, McPhee SJ, Bernstein J. Papadakis M.A., & McPhee S.J., & Bernstein J(Eds.),Eds. Maxine A. Papadakis, et al. McGraw Hill, 2022, https://accessmedicine.mhmedical.com/content.aspx?bookid=3109&sectionid=261308335.
For further information, see CMDT Part 7-22: Optic Neuritis
Subacute usually unilateral visual loss
Pain exacerbated by eye movements
Optic disk usually normal in acute stage but subsequently develops pallor
Strongly associated with demyelinating disease, particularly multiple sclerosis but also acute disseminated encephalomyelitis
Also occurs
In sarcoidosis
In neuromyelitis optica spectrum disorder
In association with serum antibodies to myelin oligodendrocyte glycoprotein
In children following viral infections
In varicella zoster virus infection
In autoimmune disorders, particularly systemic lupus erythematosus and Sjögren syndrome
In persons receiving biologics therapy (eg, anti-TNF agents and natalizumab)
In spread of inflammation from the meninges, orbital tissues, or paranasal sinuses
Unilateral loss of vision that usually develops over a few days
Vision ranges from 20/30 (6/9) to no light perception with more severe visual loss being associated with low serum vitamin D levels
Pain behind the eye, exacerbated by eye movements
Field loss is usually a central scotoma, but a wide range of monocular field defects is possible
Particular loss of color vision
A relative afferent pupillary defect
In about two-thirds of cases, the optic nerve is normal during the acute stage (retrobulbar optic neuritis)
In one-third of cases, the optic disk is swollen (papillitis) with occasional flame-shaped peripapillary hemorrhages
Visual acuity usually improves within 2–3 weeks and returns to 20/40 (6/12) or better in 95% of previously unaffected eyes
Optic atrophy develops subsequently if there has been damage to sufficient optic nerve fibers
MRI of the head and orbits should be obtained to exclude a lesion compressing the optic nerve and to identify atypical optic neuritis
In patients in whom visual recovery does not occur
In patients with other atypical features, including continuing deterioration of vision or persisting pain after 2 weeks
Intravenous methylprednisolone (1 g daily for 3 days followed by a tapering course of oral prednisolone)
Has been shown to accelerate visual recovery but not to improve final vision
In clinical practice, however, the oral taper is not often prescribed and oral methylprednisolone may be used
Use in an individual patient is determined by the degree of visual loss, the state of the fellow eye, and the patient's visual requirements
Phenytoin may be neuroprotective in typical optic neuritis
Atypical optic neuritis due to sarcoidosis, neuromyelitis optica, herpes zoster, or systemic lupus erythematosus
Requires more immediate and prolonged corticosteroid therapy
May require plasma exchange
May require long-term immunosuppression
Among patients with a first episode of clinically isolated optic neuritis, multiple sclerosis will develop in 50% within 15 years
However, the likelihood of developing multiple ...