Treatment of optic neuritis with megadose corticosteroids

Difficulty in distinguishing between monosymptomatic optic neuritis due to autoimmune disease or to intrinsic demyelination in young adults prompted a trial administration of megadose corticosteroids in a series of patients. Treatment with 1 g daily of intravenous methylprednisolone (Solu-Medrol) for 2 to 5 days led to the rapid resolution and restoration of visual function in five patients. Two untreated patients suffered irreversible loss of vision. One patient with known autoimmune disease required a higher dose. The author suggests a trial of megadose, intravenous corticosteroids in patients between the ages of 21 and 45 years with optic neuropathies of uncertain or suspected autoimmune etiology after appropriate neuro-ophthalmologic evaluation.