Ophthalmology · MU Sofia

70. Optic neuritis

Covers optic neuritis as an inflammatory and demyelinating disorder of the optic nerve, starting with its causes, where demyelinating disease such as multiple sclerosis is the most common, alongside viral, other infectious, hereditary and toxic origins. It then distinguishes three types by site of involvement, describes symptoms and signs including Marcus Gunn pupil and visual field defects, and notes recovery over weeks, the risk of atrophy after recurrent attacks, and treatment directed at the underlying cause with corticosteroids.

Inside: 1 section · 2 labelled pictures · 15 flashcards · 2 min

Topic 70 of 91 in the MU Sofia syllabus for Ophthalmology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 224 words (2 min of reading), with 15 flashcards.

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  1. Optic neuritis Topic 46

Optic neuritis Topic 46

= inflammatory and demyelination disorders of the optic nerve

Causes : large portion = idiopathic

  • Most common cause demyelinating disorders (multiple sclerosis 70% of MS develop optic neuritis, neuromyelitic optica (Devic’s disease) and periaxial encephalitis (Schilder)
  • Viral infection (measles, mumps, chicken pox, whooping cough)
  • Other infections Syphilis, Lyme disease
  • Hereditary (Leber’s disease) & toxic optic neuritis

Types (according to involvement)

  • Papillitis (+optic disc)
  • Neuroretinitis (+optic disc+ macular retina; fireworks )
  • Retrobulbar neuritis (+optic nerve behind the eyeball)

Symptoms

  • Visual loss (sudden progress &profound DD of acute neuritis
  • Dark adaption may be lower
  • DD visual problem in bright light
  • Impairment of colour vision (always present)
  • Depth perception & pain (mainly retrobulbar)

Signs

  • Visual acuity (reduced largely), impaired colour vision
  • Marcus Gunn pupil sing (DD)
  • Ophthalmoscopic: Papillitis(hyperaemia of disc &blurry margins) Disc becomes oedematous thus no cupping Slit-lamp may show inflammatory cells in Vitreous DD retrobulbar no fundus changes Visual field : central Scotoma ,Contrast sensitivity impaired

Progression : visual gain is slow and takes weeks but 75 -90 % gain good vision ,in recurrent attacks of Papillitis, atrophy will ensue thus even leading to complete blindness !

Treatment : No direct treatment but underlying causes , DD from toxic neuritis is important. Corticosteroids shorten visual loss + MRI Leber’s disease- hereditary , from 20 years , progressive visual failure and bilateral primary optic atrophy occurs

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