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
Scotoma, constant blurry vision or blurred spot, pain with eye movements, along with other systemic neurologic symptoms (if demyelinating process)
If pt is of age 20s-40s and female, autoimmune/demyelinating disease is at top of the differential. If pt is older, consider other causes
If pt 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
