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Optic neuritis

Retro-bulbar neuritis; Multiple sclerosis - optic neuritis; Optic nerve - optic neuritis

 

The optic nerve carries images of what the eye sees to the brain. When this nerve become swollen or inflamed, it is called optic neuritis. It may cause sudden, reduced vision in the affected eye.

Causes

 

The exact cause of optic neuritis is unknown.

The optic nerve carries visual information from your eye to the brain. The nerve can swell when it becomes suddenly inflamed. The swelling can damage nerve fibers. This can cause short or long-term loss of vision.

Conditions that have been linked with optic neuritis include:

  • Autoimmune diseases, including lupus, sarcoidosis, and Behçet disease
  • Cryptococcosis, a fungal infection
  • Bacterial infections, including tuberculosis, syphilis, Lyme disease, and meningitis
  • Viral infections, including viral encephalitis, measles, rubella, chickenpox, herpes zoster, mumps, and mononucleosis
  • Respiratory infections, including mycoplasma pneumonia and other common upper respiratory tract infections
  • Multiple sclerosis

 

Symptoms

 

Symptoms may include:

  • Loss of vision in 1 eye over an hour or a few hours
  • Changes in the way the pupil reacts to bright light
  • Loss of color vision
  • Pain when you move the eye

 

Exams and Tests

 

A complete medical exam can help rule out related diseases. Tests may include:

  • Color vision testing
  • MRI of the brain, including special images of the optic nerve
  • Visual acuity testing
  • Visual field testing
  • Examination of the optic disc using indirect ophthalmoscopy

 

Treatment

 

Vision often returns to normal within 2 to 3 weeks with no treatment.

Corticosteroids given through a vein (IV) or taken by mouth (oral) may speed up recovery. However, the final vision is no better with steroids than without. Oral steroids may actually increase the chance of recurrence.

Further tests may be needed to find the cause of the neuritis. The condition causing the problem can then be treated.

 

Outlook (Prognosis)

 

People who have optic neuritis without a disease such as multiple sclerosis have a good chance of recovery.

Optic neuritis caused by multiple sclerosis or other autoimmune diseases has a poorer outlook. However, vision in the affected eye may still return to normal.

 

Possible Complications

 

Complications may include:

  • Body-wide side effects from corticosteroids
  • Vision loss

Some people who have an episode of optic neuritis will develop nerve problems in other places in the body or develop multiple sclerosis.

 

When to Contact a Medical Professional

 

Call your health care provider right away if you have a sudden loss of vision in one eye, especially if you have eye pain.

If you have been diagnosed with optic neuritis, call your health care provider if:

  • Your vision decreases.
  • The pain in the eye gets worse.
  • Your symptoms do not improve within 2 to 3 weeks.

 

 

References

Eze P, Sra SK, Sra KK, Friedlaender M, Trocme SD. Immunology of neurologic and endocrine diseases that affect the eye. In: Tasman W, Jaeger EA, eds. Duane's Foundations of Clinical Ophthalmology. 2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 2,chap 35.

Jacobs DA, Guercio JR, Balcer LJ. Inflammatory optic neuropathies and neuroretinitis. In: Yanoff M, Duker JS, eds. Ophthalmology. 4th ed. Philadelphia, PA: Elsevier; 2014:chap 9.7.

Prasad S, Balcer LJ. Abnormalities of the optic nerve and retina. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 17.

Purvin V, Glaser JS. Topical diagnosis: prechiasmal visual pathways. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 2,chap 5.

 
  • External and internal eye anatomy

    External and internal eye anatomy - illustration

    The cornea allows light to enter the eye. As light passes through the eye the iris changes shape by expanding and letting more light through or constricting and letting less light through to change pupil size. The lens then changes shape to allow the accurate focusing of light on the retina. Light excites photoreceptors that eventually, through a chemical process, transmit nerve signals through the optic nerve to the brain. The brain processes these nerve impulses into sight.

    External and internal eye anatomy

    illustration

    • External and internal eye anatomy

      External and internal eye anatomy - illustration

      The cornea allows light to enter the eye. As light passes through the eye the iris changes shape by expanding and letting more light through or constricting and letting less light through to change pupil size. The lens then changes shape to allow the accurate focusing of light on the retina. Light excites photoreceptors that eventually, through a chemical process, transmit nerve signals through the optic nerve to the brain. The brain processes these nerve impulses into sight.

      External and internal eye anatomy

      illustration

    A Closer Look

     

      Self Care

       

        Tests for Optic neuritis

         

           

          Review Date: 3/15/2016

          Reviewed By: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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