[Treatment of optic neuritis]

Optic neuritis manifests itself as a reversible loss of vision. It can be a clinically isolated incident or one of the (first) manifestations of multiple sclerosis (MS). Its differential diagnosis is extensive, and management of other disorders can differ radically. In a typical case, treatment with corticosteroids hastens recovery of vision but does not affect the eventual degree of recovery. There is a substantial risk of developing MS after isolated optic neuritis (approximately 50% within 20 years), especially if asymptomatic white matter lesions are found on MRI scanning of the brain. Intravenous treatment with methylprednisolone may delay the onset of MS somewhat, but after three years the benefit of this treatment is lost. Treatment with interferon beta-Ia in high-risk patients also slows down the progression to clinically definite MS, but the long-term benefits are uncertain. MR imaging of the brain has implications for prognosis but not for treatment.