Optic neuritis is an inflammation of the optic

nerve
of either one or both eyes,, it either:
i. papillitis: if it restricted to the optic nerve
head.
ii. Retrobulbar: if the inflammation in the back
of the eye.
Usually unilateral
typically affecting young adults 18 45 yrs
More common in female
Incidence 1-5 per 100,000 per year

A. Idiopathic or May be due to :

B. Autoimmune disorder : the
immune system attack the myelin
sheath of the optic nerve, which
become swolled & inflamed, like
what happen in :
i.

Multiple sclerosis

ii. Neuromyelitis optica

C. Infections :
i.

Bacterial

ii. Viral

Changes in white matter in

Multiple sclerosis

D. Ischemic : the optic nerve is

infarcted due to occlusion or
decrease perfusion of posterior
ciliary vessels, it either:

Temporal arteritis

Non artretic: diabetes,

hypertension,
atherosclerosis.
Arteritic: temporal arteriris
which is an inflammation of
the lining
of the
arteries within the skull.
E. Toxins : exogenous , endogenous
F. Some drugs e.g. ethambutol
G. Leber's hereditary optic
neuropathy
H. Radiotherapy to the head

Anterior ischemic neuropathy

Types
Types

Acute
Acute

Chronic
Chronic

Alcohol

Tobacco

Alcohol
Tobacco
Papillitis
Papillitis retrobulbar
retrobulbar ambylopia
ambylopia ambylopia
ambylopia

Sudden visual loss

Impaired color vision varry from

blurring up to complete blindness.

Impaired contrast sensetivity

Patient see objects as it
washed out or cloud infront.
Also complain of spots,
sparkles & loud noise.

Pain in case of retrobulbar

neuritis worsened by eye

movement.

In papilli
tis opt
ic
disk swe
lling

In retrob
ulbar <
no
abnorma
l changes

y
path
o
r
u
e
ic n d is c
m
e
h
d
In isc le swolle
- > pa

sen
t
s
a
r
Cont
test

it y
v
i
t
e
s

Visual acuity
test
Visual acuity is
markedly reduced
up to no
perception of
light

Color vision
test : impaired

: RAPD
t
s
e
t
n
o
i
t
light reac
y
r
a
l
ye dont
il
e
p
d
u
e
t
P
c
e
f
f
of the a
The pupil
ect light
ir
d
o
t
t
c
rea
e indirect
h
t
o
t
t
c
a
but re

Visual field test :

Visual field test :
central scotoma
central scotoma

MRRI I
M

To diagnose
multiple sclerosis
-> abnormalities in
white matter

 It usually resolve spontaneously

but treating with steroids speed up
vision recovery.

Treatment of underlying causes

( infections, immune disorder, .. )
life style modification in diabetic &
hypertensive patients
Early treatment of vision proplems

Most cases resolve

spontaneously with return
of vision in two weeks to
three months
Some cases show
recurrence
Optic nerve damage
Decrease visual acuity
Side effects of steroids:
immunosuppresion,
Osteoporesis

Toxic reaction in optic nerve

Bilateral
symmetrical
Retrobulbar

Painless visual loss

Decrease color vision

Toxins ( tobacco , Lead, methanol, chloramphenicol, quinine)

cause damage to
optic nerve & ganglion cells, aggravated by malnutrition,
defecincies of protein, vitamin B12, antioxidant)

History of :
- exposure to toxins
- malnutrition
Visual field : paracentral scotoma
Fundus : early no changes ,
late become pale

Healthy life style

Stop exposure to toxic substances
Oral or parenteral vitamin B

Vision may improve if the cause is treated

or removed quickly.

There are no scientifically validated preventive

measures for optic neuritis. Anecdotal evidence
suggests that maintaining a healthy lifestyle with
proper attention to good nutrition, exercise,
prevention of obesity, maintenance of emotional
health and adequate rest, together with avoidance of
toxins such as cigarettes, may prevent many diseases.
Regular annual eye exams are critical to maintaining
healthy vision.
Early treatment of vision problems can prevent
permanent optic nerve damage (atrophy).