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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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 5/14/2015
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