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Optic Neuritis, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Optic nerve dysfunction due to an inflammatory process, commonly associated with myelin destruction

  • Highly associated with multiple sclerosis (MS); presenting feature in 15–20% of MS ...

Diagnosis

Signs and Symptoms

  • Vision loss and pain most common symptoms

  • Visual loss occurring over days (rarely over hours), peaks in 1–2 wk:

    • Adults usually unilateral (70%)

    • Bilateral visual loss more comm...

Treatment

Ed Treatment/Procedures

  • Early ophthalmologic and neurologic consultations

  • IV steroid pulse followed by oral steroids:

    • Recommended for those with ≥2 demyelinating lesions on MRI without a prior ...

Follow-Up

Disposition

Admission Criteria

  • Bilateral vision loss

  • If other sources of acute vision loss cannot be ruled out

  • IV steroid pulse treatment needed

Discharge Criteria

  • Unilateral visual impairment

  • Good...

Pearls and Pitfalls

  • Rule out space-occupying lesions before making the diagnosis of optic neuritis.

  • Acute bilateral loss with a severe headache or diplopia should raise concern for pituitary apoplexy.

  • T...

Additional Reading

  • Abou Zeid  N, Bhatti  MT. Acute inflammatory demyelinating optic neuritis: Evidence-based visual and neurological considerations. Neurologist.  2008;14:207–223.

  • Balcer  LJ. Clin...

Codes

ICD9

  • 377.30 Optic neuritis, unspecified

  • 377.31 Optic papillitis

  • 377.32 Retrobulbar neuritis (acute)

  • 377.39 Other optic neuritis

ICD10

  • H46.00 Optic papillitis, unspecified eye

  • H46.9 Unspecified optic ne...

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