Optic Neuritis

  • Medical Author:
    Andrew A. Dahl, MD, FACS

    Andrew A. Dahl, MD, is a board-certified ophthalmologist. Dr. Dahl's educational background includes a BA with Honors and Distinction from Wesleyan University, Middletown, CT, and an MD from Cornell University, where he was selected for Alpha Omega Alpha, the national medical honor society. He had an internal medical internship at the New York Hospital/Cornell Medical Center.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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What are symptoms of optic neuritis?

The major symptom of optic neuritis is vision loss, usually in one eye, often developing within hours to a couple of days and peaking in 1 to 2 weeks. It may vary from a small area of blurring to complete blindness. Affected individuals may also notice distorted vision, reduced color vision, loss of contrast, and washed-out or less vivid vision than normal. Symptoms may be worsened by heat or exercise. Vision loss is usually temporary, but it may be permanent in some cases.

Most people who develop optic neuritis experience eye pain that is worsened by eye movement. The intensity of the pain usually follows the course of the vision loss.

Because optic neuritis usually affects one eye, patients may be unaware of subtle visual loss or changes in the color vision until they or doctors close or cover the healthy eye.

What are signs of optic neuritis?

The most characteristic findings on examination include reduced visual acuity (typically 20/25 to 20/190), a measurable change in peripheral vision, decreased perception of brightness in the affected eye, and loss of color vision out of proportion to the loss of visual acuity. A disturbance in reaction of the pupil (afferent pupillary defect or APD) is usually detectable if the other eye is either unaffected or involved to a lesser degree.

The optic nerve can easily be visualized with an ophthalmoscope. In one-third of the cases, there is visible swelling of the optic nerve, and there may be enlargement of the blood vessels around the nerve. This condition is called papillitis. In about two-thirds of patients, inflammation is entirely retrobulbar, causing no visible changes when the physician examines the optic nerve with an ophthalmoscope. This is called retrobulbar neuritis.

Medically Reviewed by a Doctor on 5/14/2015

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