Optic Neuritis - Diagnosis and Management

 • Epidemiology: Female (75%), 18-50 years,

caucasian

 • Symptoms: Moderate visual loss (avg. 3/10), Moderate orbital pain, (Sub)acute: a few hours-10days, Unilateral

 • Signs: RAPD (Marcus Gunn pupil), Papilledema (30%), Variable pattern of VF loss, Dyschromatopsia R-G or B-Y

 • MRI: ON- focal, anterior lesions (a), Brain: normal / WM lesions (b)

 • CSF Analysis: Pleocytosis < 50/mm3 (30%), OCBs (30-70%)

 • Evolution: Improvement within < 4 weeks, No visual deterioration after withdrawal of corticosteroids

TREATMENT

• IV Methylprednisolone (MP) 1 g/d for 3-5 days (sometimes +)

• Plasma exchange :

    - Typical MS-like ON: should be considered if persistent severe visual loss after MP

    - Atypical ON : promptly if poor improvement after MP

    - AQP4 : Yes (first-line therapy?)

• Oral corticosteroids following MP : often indicated if NMOSD or sarcoidosis

• Immunosuppressive drugs: if NMOSD (AQP4 +++) or other auto-immune diseases



By Dr. Alistair Baber



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