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Optic Neuritis

Jonathan A. Barnett

Background

  • Optic neuritis is inflammation of the optic nerve. Often caused by demyelinating disease (e.g., Multiple sclerosis). Less often, can be caused by infection (viral etiology, bartonella, Lyme, syphilis, TB, toxoplasmosis) or infiltrative process (e.g., sarcoidosis, malignancy).

Presentation

  • Symptoms include scotoma, constant blurry vision or blurred spot, pain with eye movements, along with other systemic neurologic symptoms (if demyelinating process)

  • If patient is of age 20s-40s and female, autoimmune/demyelinating disease is at top of the differential

  • If patient is older, consider other causes

  • If patient is immunocompromised, infectious etiology becomes more likely

Evaluation

  • Consult both Ophthalmology and Neurology if concerned for an optic neuritis

  • MRI brain and orbits with and without contrast, thin slices, fat suppression

  • If no contraindications to imaging, obtain LP with CSF studies (glucose, protein, cell count, Gram stain, bacterial/viral cultures, RPR/VDRL, oligos, consider NMO/AQP4)

Management

  • High dose IV methylprednisolone

  • If vision continues to worsen and/or presence of other systemic neurologic symptoms despite steroid treatment, consider escalation to PLEX therapy with assistance of neurology