1. OPTIC NEURITIS
DR ADNAN

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

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

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

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

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

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

9. Inflammation of the optic nerve
OPTIC NEURITIS
PAPILLITIS
RETROBULBAR NEURITIS

10. VARIANTS
NEURORETINITIS
OPTIC PERINEURITIS

12. Neuroretinitis
Perioptic Neuritis

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

14. 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

15. IMPAIRED COLOUR VISION

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

17. DISC CHANGES

18. VISUAL FIELD

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

20. 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

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

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

23. MRI in multiple sclerosis

24. Optic nerve enlargement

25. Serology
CSF analysis - oligoclonal banding
inflammatory / infectious
cause

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

28. 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

29. 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

35. THANK YOU