What Causes Inflammation Of The Optic Nerve?

Inflammation of the optic nerve (neuritis) is a fairly common eye disease, which is diagnosed in 1-5 people per 100000 of the population. Most often it is found in men and women of young and middle age (18–40 years).

The main sign of neuritis is a rapidly progressive decrease in visual acuity. The prognosis of the disease is good, remission occurs quickly, but it all depends on the primary cause of the onset of the inflammatory process.

When treatment is started on time, the conduction and other functions of the affected nerve fibers are restored over time.(1)

What Causes Inflammation Of The Optic Nerve?

What Causes Inflammation Of The Optic Nerve?

  • Alcohol – tobacco intoxication
  • Allergic and toxic-allergic reactions
  • Autoimmune processes and other systemic diseases of the connective tissue
  • Caries
  • Chemical and drug poisoning
  • Encephalitis
  • Endocrine ophthalmopathy
  • ENT diseases
  • Eye diseases (blepharitis, uveitis, keratitis, episcleritis)
  • Herpes Zoster
  • Infections caused by staphylococci and streptococci, acute respiratory viral infections, influenza, parainfluenza
  • Meningitis
  • Metastasis
  • Multiple sclerosis
  • Orbital diseases (osteoperiostitis, tenonitis)
  • Pernicious anemia
  • Rheumatism
  • Sympathetic ophthalmia
  • Traumatic iridocyclitis
  • Tuberculosis
  • Uveomeningoencephalitis

The underlying cause of retrobulbar inflammation is most often multiple sclerosis. Further, often neuritis is the only symptom that indicates its course in the body.

Despite the expanding capabilities of medicine, it is sometimes not possible to establish the true cause of optic nerve inflammation. Then it is the idiopathic nature of the disease.(2) (3)

Pathogenesis

The first pathological changes can begin both in the fibers of the optic nerve and in the subshell space and the membranes themselves. As the disease progresses, dystrophic changes spread to other areas.

Retrobulbar – inflammation is localized between the visual cross and the orbit. Destructive changes spread to the optic nerve disc only in the late stages of the development of the disease. This explains the complexity of diagnosing inflammation of the optic nerve.

Intrabulbar – inflammation affects the optic disc and originates in the intraocular region, located between the ethmoid plate of the sclera and the level of the retina. In the case when the layer of retinal nerve fibers is additionally affected, neuroretinitis is diagnosed – a type of optical neuropathy.(2)

The Clinical Picture And Symptoms

Treatment of the chronic form is long, sometimes relapses occur after successful therapy. Thus, the main symptoms of the manifestation of the disease:

  • Blind patches in the fields (scotomas)
  • The decrease in light adaptation
  • Decreased visual function
  • High light sensitivity
  • Pain in the eyes
  • The sensation of a translucent curtain before the eyes
  • Violation of color perception
  • Visual phenomena

Apart from the above symptoms, a patient may experience other symptoms such as headaches, general malaise, and weakness.(4)

Diagnosis Of Inflammation Of The Optic Nerve

    • A history of the patient
    • Color perception check, adaptation
    • Diagnostics of the visual fields, in which it is necessary to clarify the fall out areas
    • Functional tests
    • Fundus angiography using sodium fluorescein
    • Ophthalmoscopy

Treatment For Inflammation Of The Optic Nerve

While the cause of inflammation of the optic nerve remains undetermined, or with the idiopathic nature of the disease, treatment is aimed at relieving inflammation, improving blood microcirculation, immune-correction, detoxification, and dehydration.

With neuritis, the following drugs are prescribed:

        • Adrenaline tamponade of the nasal passages is recommended
        • Antibiotics
        • Anti-inflammatory drugs
        • Antispasmodics
        • Corticosteroids
        • Dehydration drugs
        • Detoxification agents
        • Diuretics
        • Drugs affecting the metabolism of tissues
        • Drugs that improve blood microcirculation
        • Immunoglobulins
        • Injections of ATP, vitamin B complex, glutamic acid
        • Nootropics
        • Vasodilating substances

Since the treatment of neuritis is quite complicated, it is impossible to carry it out at home – the patient must be hospitalized under round-the-clock supervision of medical staff.

With a significant decrease in vision, some patients experience severe stress, as a result of which their mental state is disturbed. In such cases, the use of sedatives, antidepressants, and psychotropic drugs is justified.

To establish the true cause of inflammation, the patient is recommended to consult a therapist, neurologist, otolaryngologist, and a surgeon.

Sometimes, to eliminate the root cause of the appearance of neuritis, it is necessary to carry out surgical intervention, and only after that, it is necessary to begin conservative therapy in a hospital.

With neuritis, when the root cause is methanol poisoning, the first thing is to cleanse the body of toxic substances by washing the stomach, using salt laxatives and the introduction of alkali.(1) (5)

References:

  1. Burton EV. Optic Neuritis: Clinical Manifestations, Pathophysiology, and Management. Neuroinflammation: Elsevier; 2018:337-353.
  2. 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.
  3. Chiarello F, Marini E, Ballerini A, Ricca V. Optic neuropathy due to nutritional deficiency in a male adolescent with Avoidant/Restrictive Food Intake Disorder: a case report. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity. 2018;23(4):533-535.
  4. Falcão-Gonçalves AB, Bichuetti DB, de Oliveira EML. Recurrent optic neuritis as the initial symptom in demyelinating diseases. Journal of Clinical Neurology. 2018;14(3):351-358.
  5. Bennett JL. Optic Neuritis. CONTINUUM: Lifelong Learning in Neurology. 2019;25(5):1236-1264.

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