Optic Neuritis
Optic neuritis is inflammation of the optic nerve, leading to vision loss, pain, and potential long-term complications. Often associated with multiple sclerosis (MS).
Multiple Sclerosis (MS): A disease in which the immune system damages the protective covering of nerves. In MS, resulting nerve damage disrupts communication between the brain and the body.
Causes:
- Demyelinating diseases: Multiple sclerosis (MS), Neuromyelitis optica (NMO)
- Infections: Syphilis, Lyme disease, Tuberculosis, Viral (Herpes, Measles)
- Autoimmune diseases: SLE (Systemic lupus erythematosus is an inflammatory disease caused when the immune system attacks its own tissues.), Sarcoidosis (The growth of tiny collections of inflammatory cells in different parts of the body. The growths most commonly occur in the lungs, lymph nodes, eyes and skin.)
- Toxins: Methanol, Ethambutol, Lead poisoning
- Parainfectious: Post-viral infections
Signs & Symptoms:
- Unilateral vision loss (over hours to days)
- Pain with eye movement
- Relative afferent pupillary defect (RAPD)
- Decreased color vision (dyschromatopsia)
- Swollen or normal optic disc (papillitis vs retrobulbar neuritis)
Diagnosis & Investigations:
- Fundoscopy: Normal or swollen disc
- MRI Brain & Orbit: Demyelination signs
- Visual Evoked Potential (VEP): Shows delayed latency
- CSF Analysis: Oligoclonal bands in MS
Treatment:
- IV Methylprednisolone (1g/day for 3-5 days) → Oral Prednisolone taper
- Plasma exchange if severe
- Supportive care and avoid toxins
Papilledema
Bilateral optic disc swelling due to raised intracranial pressure (ICP).
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| CREDIT: CLEVELAND CLINIC |
Causes:
- Idiopathic Intracranial Hypertension (IIH)
- Space-occupying lesions
- Meningitis, Encephalitis
- Cerebral venous sinus thrombosis
- Hydrocephalus, Malignant hypertension
Signs & Symptoms:
- Bilateral disc swelling with blurred margins
- Headache (worse in morning)
- Transient visual obscurations
- Diplopia (due to 6th nerve palsy)
Diagnosis & Investigations:
- Fundoscopy: Hyperemic swollen disc
- Visual Field Test: Enlarged blind spot
- Brain MRI/MRV and Lumbar Puncture
Treatment:
- Address underlying cause
- Acetazolamide to reduce CSF production
- Weight loss in IIH
- Surgical intervention if mass lesion present
Optic Atrophy
Optic atrophy is irreversible degeneration of the optic nerve, leading to permanent vision loss.
.webp "Optic Atrophy")
Causes:
- Chronic optic neuritis (MS, NMO)
- Glaucoma
- Compression (tumors, aneurysm)
- Ischemic Optic Neuropathy (AION, NAION)
- Toxic/Nutritional optic neuropathy
Signs & Symptoms:
- Painless, progressive vision loss
- Pale optic disc on fundoscopy
- Reduced visual acuity and contrast sensitivity
Diagnosis & Investigations:
- Fundoscopy: Pale optic disc
- OCT: Shows retinal nerve fiber layer thinning
- VEP: Reduced amplitude
- MRI Brain/Orbit: Rule out compressive causes
Treatment & Management:
- Identify and treat the underlying cause
- Nutritional supplementation (B12, Folate)
- Low-vision aids and rehabilitation
- Monitor for progression with regular follow-ups