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Optic Neuritis

Olga Cerón, MD and Pablo I. Hernandez Itriago, MD, MHCM, FAAFP Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Inflammation of the optic nerve (cranial nerve II)

  • Most common form is acute demyelinating optic neuritis (ON), but other causes include infectious disease and systemic autoimmune dis...

DIAGNOSIS

HISTORY

  • Decreased visual acuity, deteriorating in hours to days, usually reaching lowest level after 1 week

  • Usually unilateral but can also be bilateral

  • Brow ache, globe tenderness, deep orbita...

TREATMENT

Most persons with ON recover spontaneously. 

MEDICATION

First Line

  • IV methylprednisolone has been shown to speed up the rate of visual recovery but without significant long-term benefit; consid...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Patient Monitoring

Monthly follow-up to monitor visual changes and steroid side effects 

PATIENT EDUCATION

  • Provide reassurance about recovery of vision.

  • If the diseas...

REFERENCES

1
Vedula SS, Brodney-Folse S, Gal RL, et al. Corticosteroids for treating optic neuritis. Cochrane Database Syst Rev.  2007;(1):CD001430. [View Abstract on OvidMedline]
2
Keltner JL, Joh...

ADDITIONAL READING

  • Balk LJ, Cruz-Herranz A, Albrecht P, et al. Timing of retinal neuronal and axonal loss in MS: a longitudinal OCT study. J Neurol.  2016;263(7):1323–1331. [View Abstract on Ovi...

SEE ALSO

Multiple Sclerosis 

CODES

ICD10

  • H46.9 Unspecified optic neuritis

  • H46.00 Optic papillitis, unspecified eye

  • H46.10 Retrobulbar neuritis, unspecified eye

  • H46.3 Toxic optic neuropathy

  • H46.13 Retrobulbar neuritis, bilateral

  • H46.2 N...

CLINICAL PEARLS

  • MRI is the procedure of choice for determining relative risk and possible therapy for MS prevention.

  • The ONTT showed that high-dose IV methylprednisolone followed by oral prednisone acc...

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