Optic neuritis is known to be a serious condition caused by demyelinating inflammation of the optic nerve. It is also known as optic papillitis (with the head of the optic nerve involved) and retrobulbar neuritis (with the posterior of the nerve involved). Optic neuritis is often associated with multiple sclerosis. It may lead to complete or partial loss of vision in one or both eyes.
Partial, transient vision loss (lasting less than one hour) is often an indication of early onset multiple sclerosis. Other possible diagnoses are diabetes mellitus, low phosphorus level, hyperkalaemia and others.
Signs and symptoms of optic neuritis
Among the most common symptoms are sudden partial or complete loss of vision, sudden blurred (sometimes referred to as 'foggy') vision, pain in the affected eye.
Some of the early symptoms that require investigation are:
• symptoms connected with MS (Multiple Sclerosis)
• twitching
• diminished control over movement
• lack of coordination
• slurred speech
• partial vision loss
• blurred vision
Episodes of disturbed or blackened vision may indicate moderate stage of the disorder and thus require immediate medical attention in order to prevent further loss of vision or blindness.
Other early symptoms are:
• significantly reduced night vision
• photophobia
• red or sore eyes
Sometimes patients with optic neuritis may lose color vision in the affected eye. This is especially valid with especially red. Colors may appear washed out compared to the unaffected eye.
Patients may experience difficulties judging movement in depth, a condition known as Pulfrich effect. This can be particular troublesome during driving, operating machines or with sports. Transient worsening of the affected eye’s vision is connected with overall increase of body temperature (a condition known as Uhthoff phenomenon). Glare disability is also a frequent complaint among patients with optic neuritis.
Several case studies in children demonstrate absence of pain in more than 1/2 (approx. 60%) of cases in the pediatric study population. Most common symptom in children is reported simply as 'blurriness.'
Adult optic neuritis as compared to pediatric cases show unilateral optic neuritis in adults more often. In children bilateral involvement is present much more predominantly.
In many cases, only one eye is affected. Patients may not be aware of the loss of color vision until they close or cover the other, unaffected and healthy eye.
Etiology and causes of the optic neuritis disorder
The optic nerve comprises of axons emergeing from the retina of the eye. They carry visual information to the primary visual nuclei. Most of it is relayed to the occipital cortex of the brain and is processed into vision. Inflammation of the optic nerve can cause rapid loss of vision – caused by swelling as well as the destruction of myelin sheath that covers the optic nerves.
The most common etiology is multiple sclerosis or ischemic optic neuropathy – generally a blood clot.
Nearly 50% of all patients with Multiple Sclerosis develop an episode of optic neuritis. Up tp 20-30% of the time optic neuritis is a presenting sign of the disorder (MS). At the time of presentation of optic neuritis presence of demyelinating white matter lesions on brain MRI test is a strong predictor for clinically definite MS development.
Almost 1/2 of the patients with optic neuritis also have white matter lesions that are consistent with MS.
Other common causes of optic neuritis are:
• infections
• optic nerve pinch
• methanol poisoning
• B12 deficiency
• diabetes
• eye injury
• tooth abscess
• syphilis
• lyme disease
• herpes zoster
• various autoimmune disorders
• lupus
• neurosarcoidosis
• neuromyelitis optica
Among the less common causes for optic neuritis are:
• cerebral trauma
• hemorrhage
• meningitis
• arachnoidal adhesions
• sinus thrombosis
• papilledema
• brain tumors
• abscess in the occipital region
• liver dysfunction
• late stage kidney failure
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