Optic neuritis is a disease in which the optic nerve plays an important role in visual acuity. While the cause of optic neuritis may not be clear, it may occur as a symptom of multiple sclerosis or anti-aquaporin 4 antibody-positive optic neuritis. It can also be associated with autoimmune diseases such as SLE and Sjogren’s syndrome, and infections such as viruses and due to syphilis.
Although the causes of optic neuritis vary widely, the long-term prognosis is different. Some individuals are more at risk of blindness due to this condition. Therefore, optic neuritis must be treated with appropriate causal decisions.(1)
Can Vitamin B12 Deficiency Cause Optic Neuritis?
There is a possibility of acquiring optic neuritis due to Vitamin B12 deficiency. Deficiency in vitamin B12 may impact your vision as well. It destroys the optic nerve by affecting the nervous system. Less than 1 percent of Vitamin B12 deficient individuals are subjected to optic neuritis. This results in gradual, bilateral, vision loss with no pain, which is usually related to cecocentral or central scotomas and decreased color sensitivity.(2)
Can You Go Blind From Optic Neuritis?
It may contribute to temporary loss of vision when inflamed. This is commonly found in one eye, varying from a minor blurry vision or having a blind spot. It may sometime be associated with full blindness. However, it is usually temporary and the vision is restored within 2 weeks of treatment.
Anti-aquaporin-4 antibody-positive optic neuritis is at high risk for blindness and can impair basic functions of life support, such as intractable hiccups, nausea, hemiplegia, and cardiorespiratory function. Compared to multiple sclerosis, the degree of neuropathy is stronger, and it is known that serious complications are more likely to occur.(3)
Optic Neuritis Causes
The optic nerve is behind the eyeball and connects the brain to the eyeball. It plays an important role in transmitting visual information obtained from the eyeball to the brain. The surface of the optic nerve is covered with a structure called myelin to make the electrical activity more effective.
However, myelin can be destroyed by some cause, and this phenomenon is called “demyelination.” When demyelination occurs, the speed at which electrical signals travel is markedly reduced, impairing the signal transduction mechanism and resulting in inflammation of the optic nerve. Optic neuritis includes those associated with idiopathic optic neuritis, multiple sclerosis, and anti-aquaporin 4 antibody-positive optic neuritis.(4)
Optic Neuritis Symptoms
In optic neuritis, eyesight declines from a relatively rapid course within a few days. Eye pain may occur before vision impairment, but pain may have disappeared when you become aware of vision impairment. The types of pain vary, including severe, dull, and deep inside.
The central part of the visual field is dark and difficult to see. Symptoms such as difficulty in distinguishing colors, mainly red and green, and invisible flickering may also be seen.
Further, depending on the underlying disease, symptoms other than visual impairment associated with the underlying disease may be seen. For example, multiple sclerosis is also associated with weakness and numbness in the limbs and recurrent neurological symptoms.(4)
Optic Neuritis Diagnosis
For optic neuritis, ophthalmological examinations such as visual acuity examination, visual field examination, and fundus tests are important. A visual acuity test confirms a decrease in visual acuity, and a visual field test confirms visual field impairment focusing on the center of the visual field.
A fundus examination can predict the degree of optic nerve damage and can also confirm inflammatory findings and bleeding in other areas. Also, the center flicker value is assumed.(5)
Optic Neuritis Treatment
For optic neuritis, consider initial treatment with steroid pulses. However, if it develops as idiopathic optic neuritis, improvement of symptoms can be expected by follow-up observation.
For multiple sclerosis and anti-aquaporin 4 antibody-positive optic neuritis; steroid pulse therapy is used as the first choice because the symptoms may worsen and may have a sequel.
After steroid pulse therapy, the patient may continue to take a certain number of steroids and use other immunosuppressive drugs. However, steroid pulse therapy is often unsuccessful in anti-aquaporin-4 antibody-positive optic neuritis, and plasma exchange therapy may be selected.
Optic neuritis has several causative disorders and different long-term prognosis. Therefore, it is important to determine the cause and to provide the right intervention at the right time.(5)
- Jenkins TM, Toosy AT. Optic neuritis: the eye as a window to the brain. Current opinion in neurology. 2017;30(1):61-66.
- Hassan I, Das B, Kumar S, Khalid GH, Junejo AM, Kumar R. VITAMIN B12 DEFICIENCY. The Professional Medical Journal. 2017;24(06):878-887.
- Ramdas S, Morrison D, Absoud M, Lim M. Acute onset blindness: a case of optic neuritis and review of childhood optic neuritis. Case Reports. 2016;2016.
- Bennett JL. Optic Neuritis. CONTINUUM: Lifelong Learning in Neurology. 2019;25(5):1236-1264.
- Burton EV. Optic Neuritis: Clinical Manifestations, Pathophysiology, and Management. Neuroinflammation: Elsevier; 2018:337-353.