From the Guidelines
Optic neuritis typically presents with vision loss, pain with eye movement, color vision abnormalities, and visual field defects, and is often associated with multiple sclerosis and other demyelinating disorders. The clinical features of optic neuritis, as described in the Magnims consensus guidelines 1, include visual impairment, scotoma, red-green desaturation, and pain with ocular movement. These symptoms occur due to inflammation and demyelination of the optic nerve, often associated with autoimmune processes.
Key Signs and Symptoms
- Vision loss, which can range from mild blurring to severe loss of vision in the affected eye
- Pain with eye movement, occurring in about 90% of cases
- Color vision abnormalities, particularly reduced perception of red colors (dyschromatopsia)
- Visual field defects, typically presenting as central scotomas (blind spots in the central vision)
- Flashing lights (photopsias) when moving the eyes
- Abnormal pupillary light reflex, showing a relative afferent pupillary defect (Marcus Gunn pupil) in the affected eye
- Optic disc may appear normal initially (retrobulbar neuritis) or swollen (papillitis)
Diagnostic Considerations
The presence of optic neuritis can be an isolated event or associated with multiple sclerosis and other demyelinating disorders, making neurological evaluation important for patients with these symptoms 1. The Magnims consensus guidelines suggest that optic nerve involvement should constitute an additional item to meet dissemination in space (DIS) criteria for multiple sclerosis diagnosis 1.
Prognosis and Treatment
Most cases of optic neuritis improve spontaneously within 2-3 weeks, though some visual deficits may persist 1. Early recognition and treatment of optic neuritis are crucial to prevent long-term visual impairment and to manage associated conditions such as multiple sclerosis.
From the Research
Optic Neuritis Signs and Symptoms
- Optic neuritis is an inflammatory disease of the optic nerve, usually presenting with an abrupt loss of vision, and recovery of vision is almost never complete 2, 3.
- It occurs more commonly in women than in men, and may be the initial manifestation of multiple sclerosis 2, 3.
- Common clinical findings in pediatric patients include dense visual field loss, afferent pupillary defect (APD) in unilateral cases, and papillitis that is often bilateral 4.
- Optic neuritis may occur as a clinically isolated syndrome, or in association with diffuse neurologic dysfunction, such as acute disseminated encephalomyelitis (ADEM) 4.
Treatment and Management
- The current treatment of pediatric optic neuritis consists of 3 to 5 days of intravenous methylprednisolone, followed by a prolonged oral corticosteroid taper 4.
- Bioequivalent doses of oral corticosteroids may be used as an alternative to intravenous corticosteroids to treat acute optic neuritis 5.
- Oral methylprednisolone has a non-inferior efficacy and adverse effect profile in comparison to intravenous methylprednisolone, and is more cost-effective 6.
Clinical Presentation
- Patients with acute optic neuritis often present with a subacute loss of vision, which can be severe and bilateral in pediatric patients 4.
- Visual field loss, afferent pupillary defect, and papillitis are common clinical findings in optic neuritis 4.
- The disease can occur in association with other neurologic conditions, such as multiple sclerosis or neuromyelitis optica (NMO) 2, 3, 4.