Optic neuritis

Description

Optic neuritis occurs when the swelling (inflammation) can damage the optic nerve — a bundle of nerve fibers that transmit visual information from the eye to the brain. The common symptoms of optic neuritis include pain with movement of the eye, and temporary loss of vision in one eye.

The signs and symptoms of optic neuritis can be the first indication of multiple sclerosis (MS), or it can occur later in the course of the EM . MS is a disease that causes inflammation and damage to the nerves in the brain and the optic nerve.

In addition to MS , inflammation of the optic nerve can occur with other conditions, such as infections or autoimmune diseases, like lupus. Rarely, another disease called neuromyelitis optica causes inflammation of the optic nerve and spinal cord.

Most of the people who have a single episode of optic neuritis, finally, recover your vision without the need for treatment. Sometimes the drugs of steroids may speed up the recovery of vision after optic neuritis.

Symptoms

Optic neuritis usually affects only one eye. Symptoms may include:

  • Pain. The majority of people who develop optic neuritis have eye pain that is made worse by the movement of the eyes. Sometimes the pain feels like a dull ache behind the eye.
  • The loss of vision in one eye. Most people have at least some temporary reduction in vision, but the degree of loss varies. Remarkable vision loss usually develops over hours or days, and improves over several weeks to months. The loss of vision is permanent in some people.
  • The loss of the Visual field. Side vision loss can occur in any pattern, such as loss of central vision or peripheral vision loss.
  • The loss of color vision. Optic neuritis often affects the perception of color. You might notice that the colors appear less intense than normal.
  • Flashing lights. Some people with optic neuritis report seeing flashing or flickering lights with eye movements.

When to see a doctor

Eye conditions can be serious. Some can lead to permanent loss of vision, and some are associated with other serious medical problems. Contact your doctor if:

  • You develop new symptoms, such as pain in the eye or a change in your vision.
  • Your symptoms worsen or do not improve with treatment.
  • You have unusual symptoms, including loss of vision in both eyes, double vision, numbness or weakness in one or more limbs, which may indicate a neurological disorder.

Causes

The exact cause of optic neuritis is unknown. It is believed that develop when the immune system mistakenly targets the substance that covers the optic nerve, resulting in inflammation and damage to myelin.

Normally, the myelin helps the electrical impulses to travel quickly from the eye to the brain, where they are converted into visual information. The optic neuritis disrupts this process, affecting vision.

The following autoimmune conditions are often associated with optic neuritis:

  • Multiple sclerosis.Multiple sclerosis is a disease in which your autoimmune system attacks the myelin sheath that covers the nerve fibers in the brain. In persons with optic neuritis, the risk of developing multiple sclerosis after an episode of optic neuritis is around 50% for all the life. Your risk of developing multiple sclerosis after optic neuritis increases even more if a Magnetic resonance image (MRI) shows lesions in his brain.
  • Neuromyelitis optica. In this condition, the inflammation affects the optic nerve and spinal cord. Neuromyelitis optica has similarities with multiple sclerosis, but neuromyelitis optica not to cause damage to the nerves in the brain as often as multiple sclerosis not. Even so, neuromyelitis optica is more severe than that of MS , often resulting in a decrease of the recovery after an attack in comparison with MS .
  • Myelin oligodendrocyte glycoprotein (MOG) antibody disorder. This condition can cause inflammation in the optic nerve, spinal cord or the brain. Similar to MS and neuromyelitis optica, recurrent attacks of inflammation can occur. The recovery of the myelin oligodendrocyte glycoprotein (MOG) attacks is generally better than the recovery of the neuromyelitis optica.

Multiple sclerosis. Multiple sclerosis is a disease in which your autoimmune system attacks the myelin sheath that covers the nerve fibers in the brain. In persons with optic neuritis, the risk of developing multiple sclerosis after an episode of optic neuritis is around 50% for all the life.

Your risk of developing multiple sclerosis after optic neuritis increases even more if a Magnetic resonance image (MRI) shows lesions in his brain.

When the symptoms of optic neuritis are more complex, other causes should be considered, including:

  • Infections. Bacterial infections, including Lyme disease, cat scratch fever, and syphilis, or viruses, such as measles, mumps and herpes, can cause optic neuritis.
  • Other diseases. Diseases such as sarcoidosis, behçet's disease, and lupus can cause recurrent optic neuritis.
  • Drugs and toxins. Some of the drugs and toxins have been associated with the development of optic neuritis. Ethambutol, used to treat tuberculosis, and methanol, a common ingredient in antifreeze, paints and solvents, are associated with optic neuritis.

Risk factors

Risk factors for the development of optic neuritis include:

  • Age. Optic neuritis most often affects adults between the ages of 20 to 40.
  • Sex. Women are much more likely to develop optic neuritis, which are men.
  • Of the race. Optic neuritis occurs more often in white people.
  • The genetic mutations. Certain genetic mutations may increase your risk of developing optic neuritis or multiple sclerosis.

Complications

Complications of optic neuritis can include:

  • Damage to the optic nerve. Most people have some permanent damage of the optic nerve after an episode of optic neuritis, but the damage may not cause permanent symptoms.
  • Decreased visual acuity. The majority of people regain normal or near-normal vision within several months, but a partial loss of color discrimination may persist. For some people, the loss of the vision persists.
  • Side effects of treatment. Steroids drugs used for the treatment of optic neuritis submit your immune system, which makes your body becomes more susceptible to infections. Other side effects include mood swings, and weight gain.

Optic neuritis

Diagnosis

It is likely that you see an ophthalmologist for a diagnosis, which is typically based on your medical history and an exam. The ophthalmologist is likely to perform the following laboratory tests:

  • A routine eye exam. Your eye doctor will check your vision and your ability to perceive colors and measure your side (peripheral) vision.
  • Ophthalmoscopy. During this test, the doctor shines a bright light in his eyes and examines the structures in the back of your eye. This eye test evaluates the optic disc, where the optic nerve enters the retina in your eye. The optic disc is swollen in about one-third of people with optic neuritis.
  • Pupillary light reaction test. Your doctor may move a flashlight in front of your eyes in order to see how students respond when they are exposed to bright light. If you have optic neuritis, their pupils do not contract as much as students in the health of the eyes when exposed to light.

Other tests to diagnose optic neuritis can include:

  • Magnetic resonance imaging (MRI).A Magnetic resonance imaging (MRI) uses a magnetic field and pulses of radio wave energy to take pictures of your body. During anMRIto check for optic neuritis, you may receive an injection of a solution of contrast to make the optic nerve and other parts of your brain more visible in the images. AnMRIis important to determine if there are damaged areas (lesions) in the brain. This type of injury indicate a high risk of developing multiple sclerosis. AnMRIcan also rule out other causes of visual loss, such as a tumor.
  • Blood tests. A blood test is available to detect possible infections or specific antibodies. Neuromyelitis optica is linked to an antibody that causes severe optic neuritis. People with severe optic neuritis can undergo this test to determine if you are prone to the development of neuromyelitis optica. For atypical cases of optic neuritis, the blood can also be tested for MOG antibodies.
  • The optical coherence tomography (OCT). This test measures the thickness of the nerve fiber layer of the retina, which is often the thinnest of optic neuritis.
  • Examination of the Visual field. This test measures the peripheral vision of each eye to determine if there is any loss of vision. Optic neuritis can cause any pattern of visual field loss.
  • Visual evoked response. During this test, you sit before a screen in which an alternating checkerboard pattern is displayed. Attached to the head are cables with small patches to register their brain's responses to what you see on the screen. This type of test tells your doctor if the electrical signals from your brain are slower than normal as a result of damage to the optic nerve.

Magnetic resonance imaging (MRI). A Magnetic resonance imaging (MRI) uses a magnetic field and pulses of radio wave energy to take pictures of your body. During an mri scan to check the optic neuritis, you may receive an injection of a solution of contrast to make the optic nerve and other parts of your brain more visible in the images.

A magnetic resonance imaging is important to determine if there are damaged areas (lesions) in the brain. This type of injury indicate a high risk of developing multiple sclerosis. An mri can also rule out other causes of visual loss, such as a tumor.

Your doctor may ask you to return for follow-up examination from two to four weeks after your symptoms begin to confirm the diagnosis of optic neuritis.

Treatment

Optic neuritis usually improves on its own. In some cases, medications like steroids are used to reduce inflammation in the optic nerve. The possible side effects of the treatment with steroids include weight gain, mood changes, facial flushing, upset stomach, and insomnia.

The treatment with steroids are usually given through a vein (intravenously). Intravenous steroid therapy accelerates the recovery of the view, but does not seem to affect the amount of vision that you are going to recover, typical of optic neuritis.

When therapy with steroids, an error occurs and the loss of the vision persists, a treatment called plasma exchange therapy may help some people regain their vision. Studies have not confirmed that plasma exchange therapy is effective for optic neuritis.

Prevention of multiple sclerosis (MS)

If you have optic neuritis, and you have two or more brain lesions evident on magnetic resonance imaging, you can benefit from the multiple sclerosis drugs, such as interferon beta-1a or interferon beta-1b, which can slow or help prevent multiple sclerosis (MS). These injectable medications are used to people at high risk of developing EM . Possible side effects include depression, the site of the injection, irritation and flu-like symptoms.

Prognosis

The majority of people regain near normal vision within six months after an episode of optic neuritis.

The people whose optic neuritis returns have a higher risk of development of MS , neuromyelitis optica, or myelin oligodendrocyte glycoprotein (MOG) antibody-associated disorder. Optic neuritis may re-occur in people with no underlying illnesses, and people in general have a better long-term prognosis for vision that people with MS or neuromyelitis optica.

Preparing for your appointment

If you have signs and symptoms of optic neuritis, it is likely that you see your family doctor or a doctor who specializes in the diagnosis and treatment of diseases of the eyes (ophthalmologist or neuro-ophthalmologist).

Here's some information to help you prepare for your appointment.

What you can do

Make a list of:

  • Their symptoms, especially changes in vision
  • Key personal information, including any recent stressors, major life changes and family and medical history, including recent infections and other conditions
  • All the drugs, vitamins, and other supplements that you take, including over-dose
  • Questions to ask your doctor

Have a friend or family member, if possible, to help you remember the information they give you.

For optic neuritis, questions to ask your doctor include:

  • What is likely causing my symptoms?
  • There are other possible causes?
  • What tests do I need?
  • What treatments are recommended?
  • What are the possible side effects of the medications that you are recommending?
  • How long will it take for my view to improve?
  • Does this put me at greater risk of developing multiple sclerosis, and, if so, what can I do to prevent this?
  • I have other health conditions. How can I best manage these conditions?
  • Do you have brochures or other printed material I can have? What sites do you recommend?

What to expect from your doctor

Your doctor may ask you a series of questions, such as:

  • How would you describe your symptoms?
  • How significantly decreased vision?
  • Do the colors less vivid?
  • The symptoms changed over time?
  • Nothing seems to improve or worsen your symptoms?
  • Have you noticed problems with movement and coordination, or weakness or numbness in the arms and legs?
Symptoms and treatment of Optic neuritis