Optic Neuritis

Dr.Mehreen Afzal
PGR EYE UNIT II
Definition
• Optic Neuritis is the inflammation , demyelination or infection of optic
nerve.
Epidemiology
• Caucasians
• F:M is 2:1
• Young adults
 Anatomical Types

Neuro-retinitis

Papilitis Retro-bulbar

Optic
neuritis
 Anatomical Classification Of Optic Neuritis
Papillitis Neuroretinitis Retro bulbar Retinitis

Optic nerve head affected Swelling of optic nerve head and Optic nerve affected behind eye
macula ball

Hyperemia and edema of the optic Macular star Optic disc appears normal
disc

Most common type in children Least common type Most frequent type in adults
Due to viral infections

Frequent in MS
Papillitis
Retro Bulbar Optic Neuritis
Neuroretinitis
Classification According To Etiology

Optic Neuritis

Demyelinating Para-infectious Infectious Non-infectious

 Demyelinating Optic Neuritis

• Demyelination disrupt the nervous conduction.

• Condition involving visual system are:

• Isolated optic neuritis

• Multiple sclerosis

• Devic disease

• Schilder disease
 Multiple Sclerosis

• Most common

• Idiopathic

• More common in females

• Presents in third-fourth decade with relapsing/remitting

demyelination
 Ophthalmic Features Of Multiple sclerosis
• Common:
• Optic neuritis
• Inter-nuclear ophthalmoplegia
• Nystagmus
• Uncommon:
• Ocular motor nerve palsies
• Hemianopia
Association Between Optic Neuritis And MS

• The overall 15 years risk of developing MS following an acute episode

of optic neuritis is 50%.

• Optic neuritis is the presenting feature of MS in up to 30%.

• Optic neuritis occurs at some point in 50% of patients with

established MS.
 Para-infectious
• It occurs in children and is bilateral usually.

•Causes include:

• Measles
• Mumps
• Chicken Pox
• Herpes Zoster
• Whooping cough
• Immunization
 Infections

• Sinusitis

• Cat scratch disease

• Syphilis

• Lyme disease

• AIDS
 Non-Infectious

• Systemic autoimmune diseases: SLE , Vasculitis

• Sarcoidosis

• Toxic optic neuritis

• Idiopathic
 Clinical Features

• Symptoms

• Signs

• Visual field defects

 Symptoms
• Mild dull pain with ocular movement

• Visual loss: profound, sudden and progressive

• Reduced dark adaptation

• Impaired color vision

• Phosphenes

• Frontal headache and tenderness of globe

• Similar previous episode of loss of vision

 Signs

• Reduced visual acuity to 6/18 to 6/60

• Afferent pupillary defect

• Dyschromatopsia

• Diminished light brightness sensitivity

 Signs

• Diminished contrast sensitivity

• Optic disc is usually normal

• Temporal disc pallor in the fellow eye

 Visual Field Defects

• Diffuse depression of central 30◦_most common

• Central,centrocecal,altitudinal visual field defects are also

frequent
 Investigations

• Lumber puncture: Oligo clonal bands of protein on electrophoresis

• MRI:Periventicular plaques

• Visual evoked potential: conduction delay

MRI Brain
 Optic Neuritis Treatment Trial(ONTT)

• Prospective study

• Randomized clinical trials

• 448 eligible patients(presenting with visual defect in last 8 days)

 Major Trial Findings

• The prevalence of fellow eye abnormalities

• Types of visual field defects

• Adverse effects of oral corticosteroids

• Delay in onset of MS in patients treated with IV corticosteroids-were

all anticipated
 Treatment
• Steroid Regimen:

• I/V Methylprednisolone sodium succinate 1g daily for 3 days

• Oral Prednisolone 1mg/Kg foe 11 days

• Oral therapy is tapered over 3 days

 Newer Approaches

• I/M Interferon beta-1a(generally used after second attack)

• Plasma exchange in acute severe optic neuritis

• Erythropoietin

• Rituximab
 Indications For steroid treatment
• The visual acuity within the first week of onset is worse than 6/12