Optic Neuritis

Background 

  • Inflammation of the optic nerve, most commonly due to demyelinating disease (e.g., multiple sclerosis). 
  • Less commonly caused by infections (e.g., viral, bartonella, Lyme, syphilis, TB, toxoplasmosis) or infiltrativeprocesses (e.g., sarcoidosis, malignancy).

Presentation 

  • Symptoms: Scotoma, constant blurry vision or blurred spot, pain with eye movements. May accompany systemic neurologic symptoms if demyelinating. 
  • Differential considerations: 
    • Young (20s-40s) females: Likely autoimmune/demyelinating cause. 
    • Older patients: Consider non-demyelinating etiologies. 
    • Immunocompromised patients: Infectious causes more likely.

Evaluation 

  • Consult ophthalmology and neurology if optic neuritis Is suspected. 
  • Obtain MRI brain and orbits with and without contrast (thin slices, fat suppression). 
  • If no contraindications, obtain LP with CSF studies (glucose, protein, cell count, Gram stain, bacterial/viral cultures, RPR/VDRL, oligoclonal bands, 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 neurology guidance.
Last updated on