Acute Optic Neuritis: An Update on Approach and Management

Area of Science:

• Neurology
• Ophthalmology
• Immunology

Background:

• Optic neuritis (ON) is optic nerve inflammation linked to various systemic and neurological conditions.
• It typically presents as subacute, unilateral, painful vision loss.
• Classification into typical and atypical forms is based on clinical presentation and demographics.

Purpose of the Study:

• To review diagnostic methods for optic neuritis.
• To provide an updated approach to acute optic neuritis management.
• To highlight the importance of timely intervention in preventing vision loss.

Main Methods:

• A comprehensive PubMed database search was performed.
• Included English-language journals and recent publications.
• 73 articles were included in the narrative synthesis after initial screening of 160.

Main Results:

• Atypical optic neuritis may be bilateral, present with severe vision loss (<20/200), or have unusual demographics.
• Differential diagnoses for atypical ON include neuromyelitis optica spectrum disorder (NMOSD) and MOGAD.
• Steroids and immunosuppressants are primary treatment modalities.

Conclusions:

• Accurate diagnosis through physical examination and specific tests is essential for optic neuritis.
• Early treatment initiation is critical for preserving vision, particularly in atypical presentations.
• Considering NMOSD and MOGAD is vital for atypical optic neuritis cases.