The optic neuritis (optic neuritis) is an inflammation of the optic nerve. Symptoms such as eye pain and partial or complete loss of vision usually occur unilaterally. The diagnosis is primarily clinical. Treatment depends on the underlying disease. Most cases improve spontaneously.
The optic neuritis (optic neuritis) is an inflammation of the optic nerve. Symptoms such as eye pain and partial or complete loss of vision usually occur unilaterally. The diagnosis is primarily clinical. Treatment depends on the underlying disease. Most cases improve spontaneously. Etiology The optic neuritis is most common in 20- to 40-year-olds. Most cases are due to a demyelinating disease, in particular multiple sclerosis, which can recurrences occur. The optic neuritis is often to be seen manifestation of multiple sclerosis. Among other causes: infectious diseases (eg, viral encephalitis [especially in children], sinusitis, meningitis, tuberculosis, syphilis, HIV.) tumor metastasis in the optic nerve chemicals and drugs (such as lead, methanol, quinine, arsenic, antibiotics. ) neuromyelitis optica (NMO) Rare causes include diabetes, pernicious anemia, systemic autoimmune disease, eye disease, bee stings and injuries. Often, the cause remains unknown despite thorough evaluation. The main symptoms and complaints optic neuritis syndrome is the loss of vision, which often reaches its maximum within 1 or 2 days and varies from a small central or para central scotoma until complete blindness. Most patients have mild eye pain, which feel often worse with eye movement. If the papilla is swollen, this condition is called optic neuritis. When the papilla appears normal, the state as retrobulbar (optic neuritis) is referred to. The most characteristic findings include reduced visual acuity, visual field defects, and impaired color perception (often disproportionate to the loss of visual acuity). An afferent pupillary defect is detected in general, if the contralateral eye is not or only affected to a lesser degree. The study of color vision is a useful addition. the inflammation is entirely retrobulbar at about two thirds of patients, and does not cause any visible changes in the optic nerve head. In the remaining cases are Papillenhyperämie to recognize edema in or near the papilla, vascular swelling, or a combination of these. Near or on the papilla some exudates and hemorrhage may be present. Diagnosis Clinical evaluation MRT The suspected optic neuritis, patients with typical pain and vision loss, especially when they are young. The neuroimaging, preferably MRI with gadolinium is usually carried out and can show an enlarged, enhanced optic nerve. With the aid of MRI also multiple sclerosis and NMO can be diagnosed. If the optic neuritis is associated with demyelination, can be with FLAIR sequences (Fluid Attenuated Inversion Recovery) represents the typical MRI demyelinating lesions in periventricular layer. Tips and risks Perform an MRI with gadolinium in young patients, eye movement pain and loss of vision have (z. B. decreased visual acuity or color vision, visual field defects) or an afferent pupillary defect. Prognosis The prognosis depends on the underlying disease. In most cases, there is a spontaneous recovery with normalization of vision in 2-3 months. In most patients with optic neuritis typical anamnesis and without underlying systemic disease, such as a connective tissue (collagen disease), the visual acuity recovered, although again, but in> 25% of getting a recurrence in the same eye or other eye developed. Take the MRT to analyze in the future risk of demyelinating disease. Treatment Corticosteroids Corticosteroids are an option, especially if multiple sclerosis or neuromyelitis optica is suspected. Treatment with methylprednisolone (500-1000 mg iv 1 times daily) for 3 days and then prednisone (1 mg / kg po 1 times daily) for 11 days can accelerate the recovery, but the final Visusergebnisse not differ from those, where only one observation was made. According to reports, can i.v. Corticosteroids delay the onset of multiple sclerosis by at least 2 years. By sole treatment with oral prednisone, the Visusergebnis not improved, in addition, the recurrence rate can increase. Low vision aids (eg. As magnifiers, large print devices, talking clocks) may be helpful. Other treatments, such as those that are used for the treatment of multiple sclerosis may be applied if multiple sclerosis is suspected. Summary optic neuritis (optic neuritis) is at most 20 to 40 year olds. The most common cause are demyelinating diseases, especially multiple sclerosis and neuromyelitis optica, but infections, tumors, drugs and toxins are other possible causes (1). Findings include mild pain during eye movements, blurred vision (especially disproportionate loss of color vision) and afferent pupillary defect. Perform an MRI with gadolinium. Corticosteroids and other treatments can be given, especially if multiple sclerosis is suspected. Note 1. Pittock SJ and CF Luccienetti: neuromyelitis optica and the evolving spectrum of autoimmune aquaporin-4 channelopathies: a decade later.Jahrzehnt later. Ann NY Acad Sci doi: 10.1111 / 2015 nyas.12794