Optic Neuritis

What Is Optic Neuritis?

The optic nerve carries visual information from your eye to your brain. Optic neuritis (ON) is when your optic nerve becomes inflamed. ON can flare up suddenly from an infection or nerve disease. The inflammation usually causes temporary vision loss that typically happens in only one eye. As you recover and the inflammation goes away, your vision will likely return.

Those with ON sometimes experience pain. There are other conditions with symptoms that resemble the symptoms of ON. Doctors may use optical coherence tomography (OCT) or magnetic resonance imaging (MRI) to help reach the correct diagnosis.

ON doesn’t always require treatment and can heal on its own. Medications, such as corticosteroids, can help speed recovery. Most cases of ON have complete (or nearly complete) vision recovery, but it may take up to 12 months to achieve the visual recovery.

Who Is at Risk for Optic Neuritis?

You’re more likely to develop ON if:

  • you’re a female between the ages of 18 and 45
  • you’ve been diagnosed with multiple sclerosis (MS)
  • you live at a high latitude (e.g., Northern United States, New Zealand)

What Causes Optic Neuritis?

The cause of optic neuritis isn’t well understood. Most cases are idiopathic, which means they have no identifiable cause. The most common known cause is multiple sclerosis (MS). In fact, ON is often the first symptom of MS. Optic neuritis can also be due to infection or an inflammatory immune system response.

Nerve diseases that can cause ON include:

  • MS
  • neuromyelitis optica
  • Schilder’s disease (a chronic demyelinating condition that begins in childhood)

Infections that may cause ON include:

  • mumps
  • measles
  • tuberculosis
  • Lyme disease

Other causes of ON include:

  • sarcoidosis: an illness that causes inflammation in various organs and tissues
  • Gullain-Barre syndrome: a disease in which your immune system attacks your nervous system
  • post-vaccination reaction: an immune response following vaccinations

What Are the Symptoms of Optic Neuritis?

The three most common symptoms of optic neuritis are:

  • vision loss in one eye: can vary from mild to severe and lasts for 7 to 10 days
  • periocular pain: pain around the eye that’s often worsened by eye movements
  • dyschromatopsia: inability to see colors correctly

Other symptoms can include:

  • photopsias: seeing flashing lights (off to the side), in one or both eyes
  • changes in the way the pupil reacts to bright light
  • Uhthoff’s phenomenon (or Uhthoff’s sign): when eye vision worsens with an increase in body temperature

How Is Optic Neuritis Diagnosed?

A physical exam, symptoms, and medical history form the basis of a diagnosis of optic neuritis. To ensure correct treatment, your doctor may perform additional tests to determine the cause of your optic neuritis.

Types of illness that can cause optic neuritis include:

  • autoimmune neuropathies, such as systemic lupus erythematosus
  • compressive neuropathies, such as meningioma (a type of brain tumor)
  • inflammatory conditions, such as sarcoidosis
  • infections, such as sinusitis

ON is as inflammation of the optic nerve. Conditions whose symptoms resemble ON but aren’t inflammatory include:

  • anterior ischemic optic neuropathy
  • leber hereditary optic neuropathy

Because of the close relationship between ON and multiple sclerosis, your doctor may want to perform the following tests:

  • optical coherence tomography, which looks at the nerves in the back of the eye
  • brain MRI, which uses a magnetic field and radio waves to create a detailed image of the brain
  • computed tomography (CT), which creates a cross-sectional X-ray of the brain or other parts of the body

What Are the Treatments for Optic Neuritis?

Most cases of ON recover without treatment. If your ON is the result of another condition, treating that condition will often resolve the ON.

Treatment for optic neuritis includes:

  • intravenous methylprednisolone (IVMP)
  • intravenous immunoglobulin (IVIG) 
  • interferon injections

There are possible adverse effects from the use of corticosteroids such as IVMP. Rare side effects of IVMP include severe depression and pancreatitis.

Common side effects of steroid treatment include:

  • sleep disturbances
  • mild mood changes
  • stomach upset

What Is the Long-Term Outlook?

Most people with ON will have partial to complete vision recovery within 6 to 12 months. Thereafter, healing rates decrease and damage is more permanent. Even with good vision recovery, many patients will still have a varying amount of damage to the optic nerve.

The eye is a very important part of the body. Address warning signs of lasting damage with your doctor before they become irreversible. These warning signs include your vision worsening for more than two weeks and no improvement after eight weeks.

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Demyelination: What Is It and Why Does It Happen?
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Multiple Sclerosis: New Diagnostic Criteria