Preeti Patil Chhablani - Neuro-ophthalmic Disorders

Optic neuritis often is the first neurological symptom that heralds the onset of systemic demyelinating disease, although there are numerous other causes that must be considered as well. The initial evaluation and treatment of optic neuritis is guided by the clinical presentation and, in particular, whether the condition results in papillitis or solely retrobulbar inflammation. Treatment may be offered both to reduce the period of disabling vision loss and to improve visual outcomes in some cases. Identification of optic neuritis related to viral or other infections also must be done to institute appropriate therapy in such cases. Risk of further neurological events is based upon any prior neurological symptoms as well as MRI findings at the time of vision loss. Systemic medical therapy may be indicated to prevent progression to full-blown demyelinating conditions such as multiple sclerosis (MS) or neuromyelitis optica (NMO), and the treatment strategies for these two conditions is quite different. Both the ophthalmologist and neurologist should be familiar with the acute and chronic care of individuals with optic neuritis and their long-term prognosis, as both play an important role in the short- and long-term assessment of their visual and neurological health.

Patients with vision loss from optic neuritis tend to be in the second to fourth decade of life, with women affected more frequently than men [], with recent data suggesting that worse presenting visual acuity is associated with particular systemic disorders and pathogenic mechanisms (see below). In most cases, a preceding or concurrent systemic illness is not present, and accompanying neurological symptoms such as numbness, weakness, or tingling may help to establish the nature of an underlying disease process or infectious disorder.

Incidence of optic neuritis varies depending on geographic area and population ethnicity. In a study of a largely white population in the USA, an incidence of 5.1 per 100,000 persons was noted, and prevalence was estimated at 115 per 100,000 [].

Other exam findings on presentation include infrequent vitreous cells, particularly when papillitis is present, and tenderness to palpation of the globe. Intermediate uveitis, although it has been associated with multiple sclerosis, does not have a specific association with the development of optic neuritis, and it is important that the clinician not confuse vision loss, usually painless, from uveitic macular edema with optic neuritis. Furthermore, patients with uveitis and demyelinating disease such as multiple sclerosis typically are older than optic neuritis patients, and their vision loss often is more chronic in nature [].