Optic Neuritis (cont.)

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How is optic neuritis diagnosed?

Optic neuritis is suspected based on the characteristic history of eye pain and vision loss. The standard exam includes visual acuity, pupillary reduction, visual field evaluation, color vision testing, and visualization of the optic disc by direct and indirect ophthalmoscopy.

A person experiencing a first episode of optic neuritis should undergo an MRI of the brain to look for the central nervous system lesions associated with MS. The MRI may also show an enlarged optic nerve.

Visual symptoms usually progress for the first couple weeks, and then start to improve within the first month. If the course of recovery is not typical, then there are a number of blood tests like the sed rate, thyroid function, antinuclear antibodies, etc. that can be performed to look for other causes of optic neuritis/neuropathy.

What is the treatment for optic neuritis?

If a definite cause (such as infection or underlying other disease) is determined, appropriate therapy for that cause can be instituted.

The Optic Neuritis Treatment Trial, a multicenter randomized trial with 15 years of follow-up, showed that oral steroid (prednisone) alone, had no benefit on recovery to normal visual acuity. High-dose intravenous steroids, which involve some risks and can have significant side effects in some patients - e.g. elevated blood sugar, depression, insomnia, gastrointestinal symptoms, etc. - did speed up the initial recovery of vision in the acute phase. However, there was no conclusive evidence that oral or intravenous steroids had any long-term benefit on visual acuity, visual field or contrast sensitivity five years later.

Medically Reviewed by a Doctor on 1/21/2014

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