Optic neuritis

Abstract

Aims The aim of this study is to provide a clinical update on optic neuritis (ON), its association with multiple sclerosis (MS), and neuromyelitis optica (NMO). Methods This study included a PubMed review of the literature written in the English language.Results ON in adults is typically idiopathic or demyelinating, and is characterised by unilateral, subacute, painful loss of vision that is not associated with any systemic or other neurological symptoms. Demyelinating ON is associated with MS, and we review the key studies of ON including the ON treatment trial and several other MS treatment trials and NMO. Conclusion Acute demyelinating ON can occur in isolation or be associated with MS. Typical ON does not require additional evaluation other than cranial magnetic resonance imaging. NMO is likely a separate disorder from MS and the ON in NMO has a different treatment and prognosis. Methodology The authors conducted an English language search using Pubmed from the years 1964 to 2010 using the search terms 'ON', 'MS' and 'NMO'. The authors included original articles, review articles, and case reports, which revealed new aspects as far as epidemiology, histopathology, clinical manifestations, imaging, genetics, and treatment of ON. Titles were reviewed for topicality and full references were obtained. Letters to the editor, unpublished work, and abstracts were not included in this review.

Systemic Lupus Erythematosus with Neuromyelitis Optica

“…Optic neuritis in NMO is often both bilateral and severe [21,22] and patients of NMO with optic neuritis have a higher likelihood of permanent vision loss than patients with typical optic neuritis such as multiple sclerosis (MS) [23]. In contrast to optic neuritis, myelitis in NMO is frequently transverse, and manifests as severe disturbances in both motor and sensory pathways at the same time as the appearance of disruptions to bowel and bladder functions [24].…”

Headaches attributed to visual disturbances

“…Spontaneous ocular pain exacerbated by eye movements is a typical symptom [15] that has been reported in 92 % of cases included in the Optic Neuritis Treatment Trial [16,17]. Pain usually precedes by 2 or 3 days of central visual loss characterized by impaired visual acuity, color vision and central scotoma or generalized depression on automated visual field testing.…”

Orbital Imaging

“…5). 3 Optic neuritis may be seen in the setting of neuromyelitis optica, a demyelinating disorder that attacks the optic nerves and spinal cord, which is distinct from multiple sclerosis (MS). Bilateral optic neuritis has been associated with infectious cause, such as a viral prodrome in children, although the association is not well established for adults (Fig.…”