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
#Optic #Neuritis #Diagnosis #Management #treatment #rheumatology #ophthalmology
