To date, no clinical trials or treatment guidelines for RPON have been published. Since the evaluation of effective treatments is entirely based on evidence from a limited number of case reports, there is some uncertainty surrounding the proposed efficacy of the drugs for treating RPON. Potential treatments for RPON can be divided into three main categories: preventative therapy, symptomatic treatment, and management of residual symptoms. Preventative therapy Migraine preventive medications, including beta-blockers (e.g. propranolol), calcium channel blockers (e.g. flunarizine), anticonvulsants (e.g. valproate), and antidepressants (e.g. amitriptyline), may be given to those with RPON with the intent of preventing RPON recurrence. Although the efficacy of these preventives has been proposed in various published case studies, there is a lack of compelling evidence suggesting that these anti-migraine drugs have long-term prophylactic effect on future RPON attacks. The initiation of migraine preventive therapy in RPON is only recommended for people who have typical migraine with frequent attacks as a concurrent condition. Symptomatic treatment Corticosteroids are the most frequently reported drugs for treating acute symptoms of RPON. The rationale behind their use in RPON treatment is to reduce ocular cranial nerve inflammation, which is indicated by the presence of nerve enhancement and is also theorized to be a pathophysiological mechanism of RPON, in affected individuals. Early implementation of corticosteroid therapy is considered beneficial to the majority (96.2%) of people with RPON because it can shorten their recovery time and reduce the severity of existing symptoms. Even though various studies have documented the success of using this medication to induce symptomatic relief in affected individuals, the improvement is not as rapid and significant as observed in other inflammatory diseases, such as THS and temporal arteristis. In addition, some steroid non-responders may have worsened RPON symptoms after taking these drugs, suggesting that corticosteroids are not suitable for treating every patient with the condition. Other drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), ergotamine, triptan and acetaminophen, have been investigated for the acute treatment of RPON. However, their efficacy is currently unknown. Management of residual symptoms Depending on the severity of symptoms, various treatment options are available to people with persistent<unk> . For mild conditions, prism glasses can be prescribed to correct specific types of double vision. In more extreme cases, additional intervention such as botulinum toxin injection and strabismus surgery, might be required to rebalance the actions of the extraocular muscles. This would improve the alignment of the eyes when they are in primary position. Similarly, surgical correction can be performed on individuals with severe ptosis.
Recurrent painful ophthalmoplegic neuropathy
Acute visual loss
Visual impairment due to intracranial pressure
Persistent edema of rosacea
Recurrent corneal erosion
Diffuse unilateral subacute neuroretinitis
Chronic progressive external ophthalmoplegia
Facial onset sensory and motor neuropathy