Optic neuritis


Optic nerve disorders represent a relatively common cause of visual loss.

Primary inflammation of the optic nerve.

Most often occurs between the ages of 20 and 50 years.

It is three times more frequent in women.

Visual loss usually reaches its nadir within 7 – 10 days and begins to recover within one month.

Patients often present with acute monocular vision loss that progresses of hours or days, pain with eye movement, and dyschromatopsia, the reduced contrast in colors.

Retroorbital pain particularly with eye movement, occurs in almost all cases.

Most commonly an acute demyelinating process in association with multiple sclerosis.

Optic neuritis is often associated with multiple sclerosis but can be infectious, inflammatory, paravaccination immunological response, or due to autoimmune disease.

Associated with a variety of systemic autoimmune disorders.

Presenting problem in 15-20% of patients with multiple sclerosis.

A study with patients presenting with a first episode of optic neuritis followed for 10 years 38% developed multiple sclerosis.

Risk of recurrences after a single isolated episode is at least 31% during a 10-year follow-up and is greatest among those who develop multiple sclerosis (48%).

Clinical diagnosis based on history of subacute visual loss and difficulty in perception of colors, and objects.

Pain on eye movement reported in 92% of patients.

A relative afferent pupillary defect may be seen and direct ophthalmoscopy shows diffuse optic disc edema in 1/3 of cases.

High titer of myelin oligodendrcyte glycoprotein are predominantly detected in pediatric patients with recurrent ON.

Treatment with oral corticosteroids may hasten recovery of visual defects, although it does not significantly affect long-term visual outcome.

Treatment with oral corticosteroids may be associated with an increased risk of recurrence of optic neuritis, and should be avoided.

Treatment with high-dose intravenous methylprednisolone for three days followed by oral prednisone taper recover vision faster compared to those treated with oral agents alone.

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