Optic Neuritis
Medical Author: Andrew A. Dahl, MD, FACS
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
What is optic neuritis?
Optic neuritis is inflammation of the optic nerve, the structure that
connects the eye to the brain. The optic nerve consists of nerve tracts (axons)
that originate in the retina of each eye. The optic nerve carries visual
information from the retina to the nerve cells in the brain stem, where the
information is relayed to the area of the brain that recognizes vision (the
occipital cortex).
Optic neuritis can occur in children or adults and may involve either one or
both optic nerves. Optic neuritis typically affects young adults ranging from
18-45 years of age, with a mean age of 30-35 years. There is a strong female
predominance. The annual incidence is approximately 5/100,000, with a total
prevalence estimated to be 115/100,000.
What causes optic neuritis?
The precise cause of optic neuritis is unknown, but it is thought to be a
type of autoimmune disorder. The immune system is generally used to fight
infection by creating a reaction that combats bacteria, viruses, fungi, and
other foreign proteins. In autoimmune diseases, this reaction is mistakenly
directed against a normal part of the body, creating inflammation and potential
damage. In the case of optic neuritis, the optic nerve becomes swollen and its
function is impaired. Inflammation of the optic nerve causes loss of vision
because of the swelling and destruction of the protective myelin sheath that
covers and insulates the optic nerve. Direct damage to the nerve tracts (axons)
may also play a role in nerve destruction.
Optic neuritis most commonly develops due to an autoimmune disorder that may
be triggered by a viral infection. In some people, signs and symptoms of optic
neuritis may be an indication of multiple sclerosis, a disease in which the
immune system attacks the myelin sheath covering nerve fibers in the brain and
spinal cord, resulting in inflammation and damage to nerve cells in the brain
and spinal cord. Demyelinating optic neuritis is another term for this eye
condition. In optic neuritis resulting from demyelinating disease, particularly
multiple sclerosis, there may be recurrences of optic neuritis over time.
In 15%-20% of people who eventually develop multiple sclerosis,
optic neuritis is their first symptom. The risk of developing multiple sclerosis
following one episode of optic neuritis is approximately 50% within 15
years of the episode of optic neuritis. On MRI scanning, almost half of the
patients with optic neuritis (and no history or clinical evidence of multiple
sclerosis) have abnormal brain white matter changes consistent with multiple
sclerosis. In patients undergoing MRI scans of the brain at the time of the
initial attack of optic neuritis, the finding of brain lesions on MRI images
increased the risk of development of later multiple sclerosis threefold versus
people with normal MRI scans. However, almost half of patients with any brain
lesions on MRI at the time of the initial episode of optic neuritis will not
have developed multiple sclerosis 10 years later.
Another autoimmune condition that causes optic neuritis is neuromyelitis
optica. In this unusual condition, inflammation occurs in the optic nerve and
spinal cord but usually not within the brain as often as in multiple sclerosis.
Optic neuritis arising from neuromyelitis optica is more severe than optic
neuritis associated with multiple sclerosis.
There are many causes of optic neuritis unassociated with multiple sclerosis,
including:
- Infections: Bacterial infections, including Lyme disease, tuberculosis, cat
scratch fever, toxoplasmosis and syphilis, or viral infections such as HIV
(human immunodeficiency virus), hepatitis B, and herpes zoster can cause optic
neuritis. Bacterial meningitis, encephalitis, and sinusitis (all especially in
children) may cause optic neuritis or optic nerve damage.
- Cranial arteritis:
This is an inflammation of the lining of the arteries within the skull. Inflamed
cranial arteries can block blood flow to your eyes and brain, which may cause
permanent vision loss or a stroke. Cranial arteritis is most likely to occur in
adults 60-90 years of age. This condition is also known as temporal arteritis or
giant cell arteritis (GCA).
- Diabetes: Diabetes is a condition in which the
body cannot make or properly use insulin, a hormone that regulates the amount of
sugar in the blood and other tissues. People with diabetes are at an increased
risk of developing disorders of the optic nerve, including optic neuritis, most
likely from decreased blood flow to the optic nerve.
- Sarcoidosis, pernicious
anemia, Grave's disease, bee stings, and vaccinations may cause vision loss from
optic nerve swelling.
- Autoimmune diseases (such as systemic lupus) may cause
inflammation of blood vessels (vasculitis) nourishing the optic nerve.
- Drugs.
Some drugs have been associated with the development of optic neuritis. These
include ethambutol (Myambutol) and certain antibiotics.
- Toxins: Lead, methyl alcohol,
quinine, and arsenic may cause vision loss and other symptoms that may mimic
optic neuritis.
- Radiation therapy to the head is an uncommon cause of optic
neuritis.
- Leber's hereditary optic neuropathy, an inherited form of vision
loss that affects mostly males in their 20s or 30s, may cause optic neuritis.
However, the basic cause of optic neuritis is often unknown.
The term "optic neuropathy" is a more general term used to describe any
condition that results in damage to the optic nerve. Optic neuritis is a
specific type of optic neuropathy resulting from inflammation. Common
noninflammatory causes of optic neuropathy include glaucoma, blocked or limited
blood flow, direct trauma to the optic nerve(s), many neurological diseases,
elevated intracranial pressure, primary and metastatic optic nerve tumors,
nutritional deficiencies, and toxic exposure, including alcohol and tobacco,
intraocular inflammation, and injuries. Trauma can interfere with the nerve's
ability to conduct electrical impulses. All of these may cause vision loss and
other symptoms that may mimic optic neuritis.
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