Optic neuritis can be seen as an inflammatory optic nerve lesion. Also, this disease includes nerve damage in demyelinating diseases. Within the framework of optical neuritis, intra and retrobulbar neuritis are distinguished, which differ significantly in the ophthalmoscopic picture. Common symptoms are decreased vision and cattle; with individual forms, pain in the eye is possible.
In diagnosis, ophthalmoscopy plays a paramount role. Treatment is based on a combination of anti-edematous, anti-inflammatory, desensitizing, antibacterial or antiviral, immunoprotective, detoxification and metabolic methods.(1)
What Is The Difference Between Optic Neuritis & Optic Neuropathy?
Optic neuritis entails optic nerve inflammation triggered by injury and degradation of the protective cover of the optic nerve (myelin) which is important to proper vision. Another name for this eye disease is demyelinating optic neuritis.
Signs and symptoms can involve blurry vision and blind spots. If you turn your head, you can experience blurred vision, diminished color perception, and discomfort. Both forms of symptoms may progress to loss of vision.
On the other hand, optic neuropathy explains defects or injury to the optic nerve, with triggers including trapped blood or exposure to toxic chemicals.(3)
Among the factors that provoke optic neuritis, the most common inflammatory processes affected are the orbit, the eyeball, and the brain; infectious processes in the nasopharynx. Optic neuritis can result from common infections: tuberculosis, malaria, typhus, brucellosis, acute respiratory viral infections, diphtheria, gonorrhea, etc. Among other causes include alcoholism, TBI, complicated pregnancy, systemic diseases, blood diseases, diabetes mellitus, and autoimmune disorders. Often, optic neuritis manifests in multiple sclerosis.(2)
Diagnosis Of Optic Neuritis
Since optic neuritis is an interdisciplinary pathology, its diagnosis often requires the joint participation of specialists in the field of neurology and ophthalmology. In typical cases, an ophthalmologist consultation is sufficient to verify the diagnosis, during which the patient’s complaints are compared with visual acuity, perimetry, and ophthalmoscopy.
The most important task is to differentiate the changes in the disk during optical neuritis from a stagnant disk. This is especially true for a mild course of neuritis with minimal visual impairment and with a combination of neuritis with swelling of the disc. In such cases, the identification of foci of exudation and minor hemorrhages in the disc tissue indicates neuritis. To distinguish these conditions, the help of fluorescence fundus angiography is a good choice. To exclude a congestive disc in complex cases, a neurologist consultation, echo-encephalography, and lumbar puncture may be required.
To determine the etiology of optical neuritis, it is possible to carry out an MRI of the brain, blood culture for sterility, PCR studies, ELISA, RPR test, consultation of an infectious disease specialist, rheumatologist, immunologist, etc.(4)
Optic Neuritis Progression
The inflammatory process (neuritis) can develop both in the membranes of the optic nerve and in its trunk. In this case, inflammatory edema and infiltration lead to compression of the optic fibers with their subsequent degeneration, which is the reason for the decrease in visual acuity. After the acute inflammation subsides, some fibers can restore their function, which is clinically manifested by an improvement in vision. The severe course of optical neuritis often leads to the breakdown of nerve fibers and the growth of glial tissue in their place. Atrophy of the optic nerve develops with an irreversible drop in visual acuity.
In multiple sclerosis, neuritis is based on the process of demyelination of nerve fibers – the destruction of their myelin sheath. Although demyelination is not an inflammatory process, in the medical literature and practice, the demyelinating lesion is classified as retrobulbar neuritis since their clinical symptoms are identical.(5)
Optic Neuritis Treatment
Etiotropic therapy is determined by the cause of neuritis. Treatment is carried out urgently in a hospital setting. Until the etiology of the disease is established, anti-inflammatory, dehydration, antibacterial, metabolic, desensitizing, and immuno-corrective treatments are usually used.
Prescribed broad-spectrum antibiotics (except for the aminoglycoside group), corticosteroids, acetazolamide with potassium preparations, intravenous glucose infusion, intramuscular administration of magnesium sulfate, piracetam, group B vitamins are used. Once the nature of the optic nerve lesion is established, the doctors proceed to specific etiotropic therapy (for example, anti-tuberculosis treatment, surgical treatment of tonsillitis and sinusitis).(4)
- Stunkel L, Kung NH, Wilson B, McClelland CM, Van Stavern GP. Incidence and causes of overdiagnosis of optic neuritis. JAMA ophthalmology. 2018;136(1):76-81.
- Akaishi T, Nakashima I, Takeshita T, et al. Different etiologies and prognoses of optic neuritis in demyelinating diseases. Journal of neuroimmunology. 2016;299:152-157.
- Yoo YJ, Hwang J-M, Yang HK. Differences in pupillary light reflex between optic neuritis and ischemic optic neuropathy. PloS one. 2017;12(10).
- Burton EV. Optic Neuritis: Clinical Manifestations, Pathophysiology, and Management. Neuroinflammation: Elsevier; 2018:337-353.
- Meer E, Shindler KS, Yu Y, VanderBeek BL. Adherence to Clinical Trial Supported Evaluation of Optic Neuritis. Ophthalmic epidemiology. 2019;26(5):321-328.