What Is The Best Treatment For Optic Neuritis?

Optic neuritis is a condition in which the optic nerve gets inflamed and inflammatory cells of the body damage the myelin sheath as well as nervous tissue of it. The debris gets collected and it can lead to more inflammation and hence the vicious cycle goes on. It can occur only due to a few causes out of which mainly is the autoimmune response of the body against some hidden antigens which were not exposed earlier to the immune system of the body. This response also catches the nervous tissue of the optic nerve as if it is a foreign antigen and tries to neutralize it. Few of the syndromic associations have also been found like multiple sclerosis, neuromyelitis optica, etc. Sometimes especially in children, it has been found in association with a post-vaccination inflammatory response or some viral diseases which are very rare.

What Is The Best Treatment For Optic Neuritis?

The treatment for this disease has no complete assurance that it will be successful but it is based upon curbing the autoimmune response generated by the body against the self-antigen. It can be done with the help of steroids and monoclonal antibodies. Steroids are used commonly as an intravenous form in this disease. Oral steroids can also be used but only in adults because according to a study, oral steroids have been shown to you have a negative impact upon children when given in this disease.(1)

The autoimmune response can also be neutralized by the use of monoclonal antibodies that attack the inflammatory cells of the body but it cannot eliminate the disease. Eculizumab is the only antibody found to be effective in the optic neuritis whether occurring singularly or in association with some other autoimmune disorder. It though is not completely curing the disease but it is very effective in preventing the relapse of the optic neuritis. According to various studies done in the different countries, it is found that it can prevent relapse in up to 95% of the cases whereas the chances for relapse were nearly 50% if the treatment is not given.

The best treatment modality in the children is monitoring after the vaccination or some viral illness and the treatment can be started prophylactically with steroids if the disease is suspected. Intravenous pulse steroids are preferred over oral doses of steroids because of better compliance and improvement in the disease(2). Although the disease is of autoimmune origin there is no complete treatment available for optic neuritis and once the patient has gone into complete remission there is always the chance for relapse.

In the patients of multiple sclerosis, optic neuritis can also occur in association with it. Disease limiting drugs like glatiramer, fingolimod, natalizumab, interferon-beta, etc. can be started to arrest the progression of the disease as well as limit the damage to a minimum.

If the patient is unable to recover from optic neuritis episode, then palliative care in the form of polycarbonate glasses can be provided to the patient to help the patient in visual acuity improvement.

Conclusion

Optic neuritis is an autoimmune disorder which may occur singularly as well as in association with other demyelinating disorders like multiple sclerosis, neuromyelitis optica, etc. There is no complete cure available for autoimmune disorders but the patient can go into remission even in early phases. The disease can be limited with the help of steroid therapy which can be given either in the form of intravenous steroids or oral steroids. Prednisolone and dexamethasone of the most common drugs to be used in the treatment of optic neuritis. Monoclonal antibodies like eculizumab have shown promise in preventing the relapse of the optic neuritis in about 95 to 97% of cases. There is no surgical treatment present for optic neuritis except for some laser therapies which may be performed in rare cases.

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