Optic Neuritis Disease

BASICS

DESCRIPTION

Inflammation of the optic nerve

System(s) affected: Nervous
Genetics: N/A
Incidence/Prevalence in USA: N/A
Predominant age: Typically 18-50 years
Predominant sex: Female > Male

SIGNS AND SYMPTOMS

Loss of vision, deteriorating from hours to days, usually reaching lowest level in one week
Usually unilateral in adults; bilateral disease more common in children
Tenderness of the globe, deep orbital pain or brow ache, especially with eye movement
Central, cecocentral, or arcuate visual field deficits
Decreased color vision
Apparent dimness of light intensities
Impairment of depth perception
Increase in visual symptoms with increased body temperature (Uhthoff's sign)
May be either swollen optic disk (most commonly seen in children) or normal optic disc
Relative afferent pupillary defect (Marcus Gunn pupil)

CAUSES

Idiopathic
Multiple sclerosis
Viral infections of childhood (measles, mumps, chickenpox)
Other viral infections (mononucleosis, herpes zoster, encephalitis)
Contiguous inflammation of the meninges, orbit, or sinuses
Granulomatous inflammations (syphilis, tuberculosis, cryptococcus, sarcoidosis)
Intraocular inflammations
Lead toxicity
Chronic high doses chloramphenicol
Posterior uveitis
Vascular lesions of optic nerve
Tumors
Fungal infections

RISK FACTORS

N/A

DIAGNOSIS

LABORATORY

CBC
Antinuclear antibody (ANA)
ESR
Rapid plasma reagin (RPR)
Fluorescent treponemal antibody absorption (FTA-ABS)
Serological test for syphilis

Drugs that may alter lab results: N/A Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

N/A

SPECIAL TESTS

Visual field test (preferably automated Humphrey or Octopus)
Color vision testing

IMAGING

Chest x-ray
MRI head or CT head/orbits in atypical cases or when patient is not improving after 10–14 days and other tests are negative

DIAGNOSTIC PROCEDURES

Check blood pressure
Complete ophthalmologic exam including pupillary assessment, color vision evaluation with color plates, dilated retinal examination with optic nerve assessment
Neurologic work-up

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient observation

GENERAL MEASURES

No disease specific measures

SURGICAL MEASURES

N/A

ACTIVITY

Fully active

DIET

No special diet

PATIENT EDUCATION

Reassurance about recovery of vision
If felt to be secondary to demyelinating disease, patient should be informed of the risk of developing multiple sclerosis
For patient education materials favorably reviewed on this topic, contact: National Eye Institute, Information Officer, Dept. of Health and Human Services, 9000 Rockville Pike, Bethesda, MD 20892, (301) 496-5248

FOLLOW UP

PREVENTION/AVOIDANCE

N/A

POSSIBLE COMPLICATIONS

Permanent loss of vision

EXPECTED COURSE AND PROGNOSIS

Visual acuity begins to improve 2–3 weeks after onset
Improvement continues over several months and vision often returns to normal or near normal levels
Those patients with poor vision and who receive IV steroids often recover faster
When baseline vision is good, IV steroids have no beneficial effect

MISCELLANEOUS

ASSOCIATED CONDITIONS

Over 50% of adult optic neuritis patients will develop multiple sclerosis

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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