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Optic neuritis

Definition


Disease: Optic neuritis Optic neuritis
Category: Eye diseases

Disease Definition:

An autoimmune disorder caused by a viral infection may result in optic neuritis. Optic neuritis is an inflammation of the optic nerve, the bundle of nerve fibers in the eye transmitting visual information to the brain. Common symptoms of optic neuritis include pain and temporary vision loss; occasionally, those signs and symptoms might be an indication of a condition that causes inflammation and damage to nerves in the brain and spinal cord, called sclerosis.
Vision recovery may be sped up with the use of steroid medications. Mostly, people who experience a single episode of optic neuritis finally recover their vision.
 

Work Group:


Symptoms, Causes

Symptoms:

Optic neuritis often affects one eye, even though it might take place in both eyes at the same time. Some of the symptoms of optic neuritis are:

Loss of color vision:

In this condition, the patient might notice that the colors of objects, specifically red ones, appear “washed out” or less vivid than normal for a short period of time. That is because optic neuritis usually affects the perception of colors.

Pain:

Mostly, people with optic neuritis experience eye pain that gets worse with eye movement. Pain related to optic neuritis often peaks within one week and later disappears within numerous days.

Visual loss:

The extent of visual loss related to optic neuritis differs. While some people do not notice any changes in their vision, others may have severe difficulty seeing. When vision loss takes place, it often grows over the course of a day to two weeks and might get worse by heat or exercise. Although vision loss is often temporary, but sometimes it might be permanent.
The signs and symptoms of optic neuritis may indicate to an autoimmune disorder named multiple sclerosis. The first symptom of 15 to 20% of people who finally grow multiple sclerosis is optic neuritis.

 

There are some problems that may result in vision loss, which means that eye conditions could be serious. A doctor should be seen in the case of:

Worsening symptoms:

A Doctor should be consulted when someone who has optic neuritis starts experiencing new eye pain, worsening vision or symptoms that don’t improve with treatment.

Unusual symptoms:

A Doctor could be seen in the case of experiencing unusual symptoms, such as numbness or weakness in one or more limbs that might be an indication of a neurological disorder.

New symptoms:

A doctor should be contacted in case the affected person experiences eye pain or notices a change in their vision.

 

Causes:

When light that reflects off an object enters the clear outer part of a person’s eyeball (cornea) and passes through the lens bringing the light into focus on the nerve cell layer of their eye (retina), the complex procedure of sight starts. As soon as the light hits the retina, electrical impulses are generated and carried along the optic nerve to the person’s brain, where the impulses are converted into visual information. The optic nerve is a bundle of nerve fibers covered by a fatty insulated material named myelin helping electrical impulses to speed along the nerve.

 

When the immune system attacks myelin covering the optic nerve causing inflammation and damage, optic neuritis develops young adults. Why a person’s immune system attacks its own tissue is unknown.

 

Two autoimmune conditions are usually related to optic neuritis, they are:

Multiple sclerosis:

This is a disease in which a person’s autoimmune system attacks the myelin sheath covering nerve fibers in their brain and spinal cord. A long-term study of people suffering from optic neuritis shows that the risk of growing multiple sclerosis following one episode of optic neuritis is 50 % after 15 years. A higher risk is involved with the evidence of brain lesions on MRI images. Compared with people with normal MRI scans, those with optic neuritis and abnormal MRI scans are three times more likely to grow multiple sclerosis.

Neuromyelitis optica:

Neuromyelitis optica is another autoimmune case that might result in optic neuritis. Inflammation takes place in this case in the optic nerve and spinal cord. Neuromyelitis optica isn’t the same as multiple sclerosis, for neuromyelitis optica doesn’t result in damage to the nerves in the brain as frequent as sclerosis does. Optic neuritis related to multiple sclerosis seems to be less severe than optic neuritis developing from neuromyelitis optica.

 

Some of the other conditions that may result in optic neuritis are: 

Cranial arteritis:

Cranial arteritis most likely affects adults ages 70 to 80. This condition is an inflammation of the lining of the arteries in the head. Those inflamed cranial arteries could prevent blood from flowing to the eyes and brain that might result in stroke or permanent vision loss.

Infections:

Viruses such as HIV, hepatitis B and herpes; or bacterial infections like Lyme disease, cat scratch fever and syphilis could cause optic neuritis. Additionally, some infections might contribute to a kind of optic neuritis named neuroretinitis that isn’t considered to be related with the risk of growing multiple sclerosis.

Medications:

The development of optic neuritis has been associated with some medications, such as ethambutol that is used in the treatment of tuberculosis.

Diabetes:

People suffering from diabetes are at a higher risk of growing of optic nerve disorders. Diabetes is a condition in which the body can’t make or use insulin in a proper way, a hormone regulating the amount of sugar in the blood.

 

An uncommon cause of optic neuritis is radiation therapy to the head. Additionally, any procedure that causes inflammation or compression of the optic nerve, such as tumors, nutritional deficiencies or toxins, could intervene with the ability of the nerve to conduct electrical impulses. This might result in vision loss and other symptoms that might mimic optic neuritis.

 

Some of the factors that may increase a person’s risk of developing optic neuritis resulting from autoimmune disorders include:

Sex:

Optic neuritis is twice as likely to develop in women.

Genetic mutations:

A higher risk of growing optic neuritis or multiple sclerosis may result from certain genetic mutations.

Age:

Usually, optic neuritis occurs in young adults between the ages of 20 to 45 years. The average age of onset is about 30 years. Although less frequently, but older people or children can also develop optic neuritis.

Race:

White people are more likely to develop optic neuritis.
 

Complications

Complications:

Optic neuritis may cause some of these complications:

Decreased visual acuity:

Up to 10% of people with a history of optic neuritis have a long-term vision loss of some extent. Vision loss might remain after the improvement of optic neuritis.

Treatment side effects:

Long-term usage of steroids might cause thinning of the bones (osteoporosis), in addition to the subduction of the immune system causing the body to become more vulnerable to infections.

Optic nerve damage:

Usually, following an episode of optic neuritis, people may experience some permanent optic nerve damage, but they may not experience any symptoms.
 

Treatments:

While steroid medications are used in the treatment of some cases of optic neuritis since they help reduce inflammation in the optic nerve, but this condition often improves on its own. In the case of receiving steroids, the treatment might involve:

Intravenous steroids:

Intravenous steroid therapy is commonly used for a few days. Although this therapy doesn’t seem to affect the ultimate level to which the patients will recover their vision, but it might accelerate vision recovery.

Oral steroids:

After intravenous steroid therapy, a person might take an oral steroid named prednisone for about two weeks. Since the use of oral steroids in treating optic neuritis has been related to a higher risk of reoccurrence, oral steroids are usually used after am intravenous course of steroids.

 

In the cases of failure in steroid therapy and the persistence of severe vision loss, some people recover their vision with the help of a treatment called plasma exchange therapy.

 

HOW TO PREVENT MULTIPLE SCLEROSIS:

when someone has optic neuritis and is at an increased risk of growing multiple sclerosis, they might benefit from medications that help block multiple sclerosis. These medications include interferon beta-1a and interferon beta-1b. People suffering from optic neuritis who have two or more brain lesions evident on MRI scans may benefit from these injectable medications to stop or delay the growth of multiple sclerosis.
 

Prognosis:

Optic neuritis usually has a good prognosis. Mostly, within six months after an episode of optic neuritis, people regain almost their normal vision.

 

In some cases, recurrent attacks of optic neuritis after recovering from the initial episode may be experienced by people suffering from neuromyelitis optica or multiple sclerosis. People who have optic neuritis with no underlying conditions have a better prognosis for their vision in the long term than those with neuromyelitis optica.
 

Expert's opinion

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