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Optic Neuritis

Optic Neuritis

Optic Neuritis

Inflammation of optic nerve; idiopathic or associated with
systemic disease; most common optic neuropathy in people
<45 years old; female preponderance.

Findings: acute unilateral visual loss (can evolve over 1st
week, then spontaneous improvement over weeks [70%
regain 20/20]), ocular pain exacerbated by eye movements,
decreased color vision and contrast sensitivity, positive
RAPD, VF defect (50% diffuse, 20% central scotoma, rarely
altitudinal), optic nerve appears normal or swollen (35%),
disc pallor late.

Other findings:
Pulfrich phenomenon: motion of pendulum appears
elliptical owing to altered depth perception from
delayed conduction in the demyelinated nerve
Uhthoff’s symptom: worsening of symptoms with heat or
exercise; present in 50% after recovery
Phosphenes: flashes of light induced by eye movements or
sound
Auditory clicks: CN 7 innervates stapedius, and patient
hears click with effective transmission.

DD: idiopathic, MS, syphilis, sarcoidosis, Lyme disease,
Wegener’s granulomatosis, systemic lupus erythematosus
(SLE), Devic’s syndrome (bilateral optic neuritis and
transverse myelitis)

Treatment:
In general, about 30% develop MS within 4 years and
38% develop MS by 10 years (risk is higher in women
than men)
Consider treating optic neuritis with IV steroids; do not
initiate treatment with oral steroids
Regardless of MRI status, there is a higher risk of
developing MS if the patient has previous neurologic
symptoms or a history of optic neuritis in the fellow eye.

Controlled High-risk Avonex Multiple Sclerosis Prevention
Study (CHAMPS): randomized trial of interferon
beta-1a (Avonex) for the prevention of MS after acute
demyelinating episode and abnormal MRI
3-YEAR RESULTS: risk of MS lower and fewer MRI
lesions in treatment group

Optic Neuritis

Optic Neuritis

Source: 

Ophthalmology Atlas(Photos of cases)

Optic Neuritis

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Optic Neuritis Inflammation of optic nerve; idiopathic or associated with systemic disease; most common optic neuropathy in people <45 years old; female preponderance. Findings: acute unilateral visual loss (can evolve over 1st week, then spontaneous improvement over weeks [70% regain 20/20]), ocular pain exacerbated by eye movements, decreased color vision and contrast sensitivity, positive RAPD, …

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