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Optic Neuritis(Inflammation of Optic Nerve)

Pronounced: op-TIK nu-RI-tis

Definition

The optic nerve allows you to see by carrying images from your eye to your brain. Optic neuritis involves inflammation 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

Optic neuritis has several causes. These include:

  • Multiple sclerosis (MS)—most common cause
  • Neuromyelitis optica (NMO, Devic’s disease)
  • Autoimmune disorders, such as Systemic lupus erythematosus (SLE)
  • Infection
  • Exposure to toxic substances—this may be associated with optic neuropathy (injury to the optic nerve)
  • Some medications

In some, the cause of optic neuritis may be unknown.

Risk Factors

Factors that may increase your chance of optic neuritis include:

  • Personal or family history of multiple sclerosis or other autoimmune disorders
  • Previous history of optic neuritis
  • Previous history of transverse myelitis (inflammation of the spinal cord)
Symptoms

In some people, optic neuritis may not cause any visual problems. In those that have them, optic neuritis may cause:

  • Relatively sudden decrease in vision, such as blurring, darkening, or dimming of vision
  • Loss of vision in the center of, part of, or all of the visual field
  • Abnormal color vision, such as dull and faded colors
  • Pain in or around the eye, which is often made worse with eye movement

Eye pain will often go away within a few days. Vision problems will improve in the majority of people. Some 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 (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 (VEP)

Your doctor may need to test your bodily fluids. This can be done with:

  • Blood tests
  • Lumbar puncture to check the cerebrospinal fluid that protects the brain and spinal cord

Your doctor may need pictures of your internal bodily structures. This can be done with an MRI or optical coherence tomography (OCT).

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 medication to reduce swelling of the optic nerve
  • Medication to treat the cause of optic neuritis
Prevention

There are no current guidelines to prevent optic neuritis.

RESOURCES:

Eye Smart—American Academy of Opthalmology
http://www.geteyesmart.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, et al. 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, et al. Management of acute optic neuritis. Lancet. 2002;360:1953-1962.

Lis SY, Birnbaum AD, et al. 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 December 24, 2013. Accessed August 21, 2014.

Romero RS, Gutierrez Y, et al. Homonymous hemimacular thinning: a unique presentation of optic tract thinning in neuromyelitis optica. J Neuroophthalmal. 2012;32(2):150-153.

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



Last reviewed August 2014 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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