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Optic neuritis

Definition​

  • Optic neuritis = Inflammation of the optic nerve

  • Most commonly caused by demyelinating disease such as multiple sclerosis (MS)​​

    • ​however this is not the only cause  â€‹

  • up to 75% may get MS over the following 15 years​

  • approximately 70% of patients with MS develop optic neuritis at some point within their disease course

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Presentation

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  • Young people typically affected

    • aged 20-50 years

  • Usually unilateral, often recurrent

  • Painful eye movements

    • Every time eye moves around, nerve is moved; if swollen, causes pain

  • Reduced visual acuity

  • RAPD often present

  • Visual field defects

    • May be central scotoma or altitudinal visual field defect 

  • Impaired colour vision

    • Red desaturation is characteristic 

  • Symptoms usually worsen over 2 weeks, then gradually get better over following 1-2 months

  • Examination:

    • May have unilateral disc swelling

    • Optic disc may also look normal

      • Sometimes inflammation occurs in the part of the optic nerve behind the eyeball and optic disc is spared (retrobulbar optic neuritis)

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Treatment 

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  • some ophthalmologists advocate treatment with a course of systemic steroid medication although the evidence to justify this is not clear-cut

    • may speed up improvement of vision, but ultimate visual outcomes are not improved​

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Prognosis

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  • Almost all patients show some improvement in visual acuity, but complete return to baseline vision is rare

    • in some cases, improvement in visual acuity is seen but may be left with permanent colour vision defect

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References

  • Denniston, A. K. O. and Murray, P. I. (eds) (2018) Oxford handbook of ophthalmology. 4th edn. London, England: Oxford University Press (Oxford Medical Handbooks). doi: 10.1093/med/9780198804550.001.0001.

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