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Published on: April 14, 2014
The Diagnosis and Treatment of Optic Neuritis
Helmut Wilhelm1, Martin Schabet
1University Eye Hospital, University Hospital Tübingen, Department of Neurology, Klinikum Ludwigsburg.
Background:
Typical optic neuritis is often the presenting manifestation of multiple sclerosis (MS). Its incidence in central Europe is 5 cases per 100 000 persons per year.
Methods:
This review is based on articles retrieved by a selective search of the PubMed database, on the pertinent guidelines, and on the authors' clinical experience.
Results:
The diagnosis of optic neuritis is based on a constellation of symptoms and signs. The onset is usually with pain on eye movement in one eye and subacute visual loss. In unilateral optic neuritis, the direct pupillary light reflex is weaker in the affected eye. One-third of patients with optic neuritis have a mildly edematous optic disc. The visual disturbance resolves in 95% of cases. A less favorable course may be evidence of neuromyelitis optica, and macular involvement may be evidence of neuroretinitis. High-dosed intravenous methylprednisolone therapy speeds recovery but does not improve the final outcome. The risk that a patient with optic neuritis will later develop multiple sclerosis can be assessed with an MRI scan of the brain.
Conclusion:
Optic neuritis is easy to distinguish from otherv diseases affecting the optic nerve. Atypical forms of this disease and other optic nerve diseases require special treatment. For patients judged to be at high risk of developing multiple sclerosis, immune prophylaxis with beta- interferon or glatiramer acetate is recommended.
Insights
Optic neuritis, often the first sign of multiple sclerosis (MS), typically presents with eye pain and vision loss. Early MRI can predict MS risk, and treatment may involve steroids or immune prophylaxis.
Area of Science:
- Neurology
- Ophthalmology
Background:
- Optic neuritis frequently serves as the initial clinical presentation of multiple sclerosis (MS).
- The incidence of optic neuritis in Central Europe is approximately 5 cases per 100,000 individuals annually.
Purpose of the Study:
- To review the diagnosis, clinical course, and management of optic neuritis.
- To discuss the association between optic neuritis and multiple sclerosis (MS).
Main Methods:
- Literature review utilizing PubMed database searches.
- Analysis of relevant clinical guidelines.
- Incorporation of authors' clinical expertise.
Main Results:
- Diagnosis relies on symptoms like eye pain on movement and subacute vision loss, with characteristic pupillary light reflex abnormalities.
- Most cases (95%) resolve, but atypical presentations may indicate neuromyelitis optica or neuroretinitis.
- Intravenous methylprednisolone accelerates recovery but doesn't alter the final visual outcome; brain MRI can assess future multiple sclerosis risk.
Conclusions:
- Optic neuritis is generally distinguishable from other optic nerve disorders, though atypical forms necessitate specific treatments.
- For individuals at high risk of developing multiple sclerosis, prophylactic treatment with beta-interferon or glatiramer acetate is advised.
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