Optic neuritis

Anthony T Reder MD (Dr. Reder of the University of Chicago served on advisory boards and as a consultant for Bayer, Biogen Idec, Caremark Rx, Genentech, Genzyme, Novartis, Questcor/Malinkrodt, Serono, and Teva-Marion.)
Originally released January 24, 1996; last updated June 22, 2016; expires June 22, 2019

This article includes discussion of optic neuritis, acute axial neuritis, acute optic neuritis, acute optic neuropathy, acute retrobulbar neuritis, and retrobulbar neuritis. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

The author describes optic neuritis, part of a spectrum of demyelinating diseases that includes multiple sclerosis. This update includes information on the diagnosis of optic neuritis, how OCT and MRI lesions affect prognosis, and the overlap of optic neuritis with neuromyelitis optica.

Key points

 

• Optic neuritis can occur alone or as a symptom of multiple sclerosis.

 

• Optic nerve inflammation causes subacute loss of vision, usually in one eye, and usually associated with retro-orbital pain.

 

• Clinical recovery is often substantial or complete, but ocular coherence tomography (OCT) shows residual thinning of the retinal nerve fiber layer in the affected eye, and often reveals thinning in the normal fellow eye.

 

• High-dose glucocorticoid therapy speeds up recovery of the inflammation, but has no long-term benefit.

Historical note and terminology

Jean-Martin Charcot recorded the best early descriptions of optic neuritis. He reported an account of a woman with multiple sclerosis and feebleness of vision in 1835, illustrating a link between the 2 diseases (DeJong 1970). Sequin published the first American reports of "disseminated cerebrospinal sclerosis," including cases of optic neuritis with subacute transverse myelitis. A more detailed historical description, starting with Arabic texts in the ninth century that began to distinguish between eye paralysis and abnormal perception, is detailed by Volpe (Volpe 2001). Adie, Denny-Brown, and McAlpine all stated that unilateral retrobulbar neuritis was a symptom of multiple sclerosis (Kurtzke 1970). However, many patients with optic neuritis do not develop multiple sclerosis. This suggests there is a spectrum from a sole demyelinating episode, to a forme fruste of multiple sclerosis, to one of the many signs of definite multiple sclerosis. Severe optic neuritis could be from neuromyelitis optica/Devic disease, but the pathogenesis is different from the multiple sclerosis-related idiopathic optic neuritis. This article focuses on optic neuritis as an isolated inflammatory demyelinating syndrome.

The content you are trying to view is available only to logged in, current MedLink Neurology subscribers.

If you are a subscriber, please log in.

If you are a former subscriber or have registered before, please log in first and then click select a Service Plan or contact Subscriber Services. Site license users, click the Site License Acces link on the Homepage at an authorized computer.

If you have never registered before, click Learn More about MedLink Neurology  or view available Service Plans.