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  • Updated 08.22.2023
  • Released 01.24.1996
  • Expires For CME 08.22.2026

Optic neuritis



The author describes optic neuritis, which is part of a spectrum of demyelinating diseases that includes multiple sclerosis. This update includes information on the diagnosis of optic neuritis, how optical coherence tomography and MRI lesions affect prognosis, and the overlap of optic neuritis with neuromyelitis optica spectrum disorders and antimyelin oligodendrocyte glycoprotein associated encephalomyelitis.

Key points

• Optic neuritis can occur alone or as a symptom of an underlying CNS autoimmune or demyelinating process like multiple sclerosis. Inflammation of the optic nerve can also be from infection, granulomatous disease, and paraneoplastic and metabolic disorders.

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

• Clinical recovery and prognosis will vary depending on the etiology. The prognosis of optic neuritis from multiple sclerosis is good with substantial or complete recovery at 6 to 12 months after onset of symptoms. However, fundoscopy and ocular coherence tomography shows residual thinning of the retinal nerve fiber layer in the affected eye and often reveals thinning in the normal fellow eye as well. Thus, bilateral optic neuritis is common, even if not apparent.

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

Historical note and terminology

Jean-Martin Charcot gave 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 two diseases (48). Sequin published the first American reports of "disseminated cerebrospinal sclerosis," including 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 (225). Adie, Denny-Brown, and McAlpine all stated that unilateral retrobulbar neuritis was a symptom of multiple sclerosis (130). 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 differs from multiple sclerosis-related idiopathic optic neuritis. This article focuses on optic neuritis as an isolated inflammatory demyelinating syndrome.

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