OPTIC NEURITIS DR ADNAN

OPTIC NEURITIS Optic neuritis is defined as inflammation of the optic nerve.

Etiology Isolated/idiopathic Infectious and Para infectious Post vaccination Inflammatory Toxic optic neuritis

Local causes Endophthalmitis Orbital cellulitis Sinusitis Contaguous spread from meninges, brain base of skull

Endogenous infections Viral – influenza, measles, mumps,chickenpox, herpes zoster Bacterial – TB, syphilis Fungal – Cryptococcosis, histoplasmosis Protozoal – Toxoplasmosis Parasitic - cysticercosis

Idiopathic Optic Neuritis Primary demyelinating process Forme fruste of multiple sclerosis Three forms Primary optic neuritis ACUTE CHRONIC Subclinical

Epidemiology Acute form most common Annual incidence-1-5 per 100,000 per year Age -20 -50 yrs Females more affected

Inflammation of the optic nerve OPTIC NEURITIS PAPILLITIS RETROBULBAR NEURITIS

VARIANTS NEURORETINITIS OPTIC PERINEURITIS

Neuroretinitis Perioptic Neuritis

SYMPTOMS VISUAL LOSS PAIN IMPAIRMENT OF COLOUR VISION MOVEMENT OF PHOSPHENES EPISODIC TRANSIENT OBSCURATION OF VISION (UHTHOFFS symptom) Impaired depth perception (Pulfrichs phenomenon)

SIGNS REDUCED VISUAL ACUITY Loss of vision typically over hours to days Unilateral/bilateral 18 to 45 yrs of age Deep orbital, retroocular or brow pain aggravated by eye movement nd increased by pressure on globe Neuralgia and headache

IMPAIRED COLOUR VISION

PUPIL – ILL SUSTAINED constriction to light MARCUS GUNN PUPIL – RAPD

DISC CHANGES

VISUAL FIELD

Differential Diagnoses Papilledema Ischemic optic neuropathy Papillophlebitis , CRVO Diabetic papillopathy Hypermetropia ONH drusen

RECOVERY Visual recovery is slower than the rate of visual loss & usually starts within 2 weeks & takes between 4-6 weeks. 75% to 90% get good visual recovery. However recurrent attacks of Retrobulbar neuritis are followed by Primary Optic Atrophy

Rule out Investigations Other etiologies e.g. compressive lesions Other inflammatory causes Determine visual and neurological prognosis

MRI Identifies abnormalities in white matter in periventricular region(demyelination) Optic nerve enlargement Nerve demyelination and enhancement Strongest predictor of MS

MRI in multiple sclerosis

Optic nerve enlargement

Serology CSF analysis - oligoclonal banding inflammatory / infectious cause

Treatment-ONTT Objectives Assessment of steroid efficacy Clinical profile of optic neuritis Natural history Relationship to MS

Intra venous Methyl prednisolone-250mg 4times a day for 3 days followed by oral prednisolone 1 mg /kg/day for 11 days Short oral taper-20 mg on day 15 10 mg on days 16 &18 Recovery of vision faster greater in 1st 15 days No significant difference after 1 yr Decreases rate of dvpt of MS in 1st 2 yrs

Recurrence rate double and increased rate of new attacks in fellow eye if oral steroid alone Therefore….. I/v steroids if.. only MRI significant value for MS prevention in long run unproved Interferon beta 1-a considered in high risk cases

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