Optic neuritis
Inflammation damages the optic nerve, which can cause pain with eye movement and temporary vision loss in one eye.
Signs and symptoms of optic neuritis may be the first indication of multiple sclerosis (MS) or they may occur later in the course of MS. MS is a disease that causes inflammation and damage to nerves in your brain as well as the optic nerve.
Inflammation of the optic nerve can occur along with other conditions, such as infections or immune diseases. Rarely, a condition called neuromyelitis optica causes inflammation of the optic nerve and spinal cord.
Most people who have an episode of optic neuritis eventually regain their vision without treatment. Sometimes steroid medications may speed the recovery of vision after optic neuritis.
Symptoms
Optic neuritis usually affects one eye. Symptoms could include: -Sensitivity to light -Blurred vision -Tiredness
- Pain.People who develop optic neuritis often have pain that worsens when they move their eyes. The pain can feel like a dull ache behind the eye.
- Vision loss in one eye.Most people experience some temporary reduction in vision, but the extent of damage varies. You might start to notice decreased vision right away, but it will gradually get worse over time. Some people experience more significant vision loss that progresses over hours or days and eventually improves over weeks to months. Loss of vision is permanent in some people.
- Visual field loss.Any pattern of side vision loss can occur, such as central vision loss or peripheral vision loss.
- Loss of color vision.Color perception may be affected in people with optic neuritis. You might notice that colors appear less vividly than normal.
- Flashing lights.Some people with optic neuritis report seeing lights that flash or flicker when they move their eyes.
When to see a doctor
If you have an eye condition, be sure to contact your doctor. Some of these conditions can lead to permanent vision loss and some are associated with other serious medical problems.
- You develop new symptoms,If you experience eye pain or see a change in your vision, it is probably not anything serious.
- Your symptoms worsen or don't improve with treatment.
- You have unusual symptoms,If you are experiencing vision loss in both eyes, double vision, or numbness or weakness in one or more limbs, this could be a sign of a neurological disorder.
Causes
The cause of optic neuritis is unknown. It may develop when the immune system mistakenly targets the substance that covers your optic nerve, resulting in inflammation and damage to the myelin.
The myelin sheath helps electrical impulses travel quickly from the eye to the brain, where they are converted into visual information. Optic neuritis disrupts this process, which affects vision.
Some autoimmune conditions are often associated with optic neuritis, including:
Multiple sclerosis.Multiple sclerosis is a disease in which your immune system attacks the myelin sheath that covers nerve fibers in your brain. In people with optic neuritis, the risk of developing multiple sclerosis after one episode of optic neuritis is about 50% over a lifetime.
If an MRI scan shows lesions on your brain, your risk of developing multiple sclerosis increases even more.
- Neuromyelitis optica. Inflammation can affect the optic nerve and spinal cord in this condition. Neuromyelitis optica is similar to multiple sclerosis, but it does not often damage the nerves in the brain as multiple sclerosis does. It is more severe than MS. MS often results in a quicker recovery than does Lyme disease.
- This passage is about a disorder in which someone has an antibody against the myelin oligodendrocyte glycoprotein (MOG).This condition can cause inflammation to the optic nerve, spinal cord, or brain. In some cases, this inflammation might recur. Recovery from MOG attacks usually is better than recovery from neuromyelitis optica.
If optic neuritis symptoms are more complex, other causes must be considered, including: Optic neuritis can be caused by many different things, and if the symptoms are more complicated, other factors may need to be considered.
- Infections.Bacterial infections, such as Lyme disease, cat-scratch fever, and syphilis, or viruses, such as measles, mumps, and herpes, can cause optic neuritis.
- Other diseases.Recurrent optic neuritis can be due to diseases such as sarcoidosis, Behcet's disease, and lupus.
- Drugs and toxins.Some drugs and toxins have been linked to the development of optic neuritis. Ethambutol, which is used to treat tuberculosis, and methanol, which is commonly found in antifreeze paints and solvents, have been linked to optic neuritis.
Risk factors
There are risk factors for developing optic neuritis, including:
- Age.Optic neuritis most often affects adults in their 20s to 40s.
- Sex.Women are more likely than men to develop optic neuritis.
- Race.People of white race are more likely to develop optic neuritis.
- Genetic mutations.Some genetic mutations might increase your risk of developing optic neuritis or multiple sclerosis.
Complications
Complications that may arise from optic neuritis may include: Some complications may include: There are many possible complications that may arise from optic neuritis, such as difficulty seeing, headaches, and trouble hearing.
- Optic nerve damage.Many people have some permanent optic nerve damage after an episode of optic neuritis, but the damage might not cause permanent symptoms.
- Decreased visual acuity.Most people regain their normal or near-normal vision within several months but some people might still have a decreased ability to see colors correctly.For some people, vision loss continues even after treatment.
- Side effects of treatment.Steroid medications used to treat optic neuritis weaken your immune system, which allows you to become more susceptible to infections. Other side effects may include mood changes and weight gain.
Diagnosis
An ophthalmologist will usually make a diagnosis based on your medical history and an examination. They may do the following tests:
- A routine eye exam.Your eye doctor will check your vision and your ability to see colors and perceive distance.
- Ophthalmoscopy.During this exam your doctor will shine a bright light into your eye and examine the back of your eye. This test evaluates the optic disk, where the optic nerve enters your retina. In about one-third of people with optic neuritis, the optic disk becomes swollen.
- Pupillary light reaction test.Your doctor may move a flashlight in front of your eyes to see how your eyes react when they are exposed to bright light. If you have optic neuritis, your eyes will not constrict as much as normal eyes would when exposed to light.
Other tests to diagnose optic neuritis might include: -A physical examination to look for changes in vision -An MRI scan of the brain -A blood test to check for signs of inflammation
Magnetic resonance imaging (MRI).An MRI scan uses a magnetic field and pulses of radio waves to create pictures of your body. When an MRI is used to check for optic neuritis, you might receive an injection of a contrast solution to make the optic nerve and other parts of your brain more visible on the images.
An MRI is important to determine if there are damaged areas in your brain. If there are lesions, this indicates a high risk of developing multiple sclerosis. An MRI can also rule out other causes of vision loss such as a tumor.
- Blood tests. A blood test is available to check for infections or specific antibodies. Neuromyelitis optica is linked to an antibody that can cause severe optic neuritis. People with severe optic neuritis may have this test to determine whether they're likely to develop neuromyelitis optica. For people with atypical (not standard) symptoms, the test may be performed to identify which antibodies they have. If someone has optic neuritis, their blood may also be tested for MOG antibodies.
- Optical coherence tomography (OCT).This test measures the thickness of the eye's nerve fiber layer, which is often thinner from optic neuritis.
- Visual field test.This test measures the vision of each eye to see if there is any loss. Optic neuritis can cause any type of visual field impairment.
- Visual evoked response. This test is used to see if your brain is functioning normally. You are sitting in front of a screen that has an alternating checkerboard pattern displayed. Small patches are attached to your head so that your doctor can see how your brain responds. This person is moving slower than usual as a result of optic nerve damage.
Your doctor will likely have you come back for follow-up exams two to four weeks after your symptoms begin to confirm that you have optic neuritis.
Treatment
In most cases, optic neuritis improves on its own. Sometimes steroid medications are used to reduce inflammation in the optic nerve. Possible side effects of steroid treatment include weight gain, mood changes, facial flushing, stomach upset, and insomnia.
Steroid treatment is usually given through a vein (intravenously). It speeds up vision recovery, but it doesn't appear to affect the amount of vision that you will recover in cases of typical optic neuritis.
If steroid therapy doesn't work and severe vision loss persists, a treatment called plasma exchange therapy might help some people recover their vision. Studies haven't yet confirmed that plasma exchange therapy is effective for optic neuritis.
Preventing multiple sclerosis (MS)
If you have optic neuritis and there are two or more brain lesions visible on MRI scans, you might benefit from multiple sclerosis medications such as interferon beta-1a or interferon beta-1b. These injectable medications are used to help prevent MS in people at high risk. Some potential side effects of this medication include depression, injection site irritation, and flu-like symptoms.
Prognosis
Most people recover their near-normal vision within six months after having an optic neuritis episode.
People who have optic neuritis are at a greater risk of developing MS neuromyelitis optica, or an MOG antibody-associated disorder. Optic neuritis can recur even in people without underlying conditions and those people usually have a better long-term prognosis for their vision than do people with MS or another MOG antibody-associated disorder. Neuromyelitis optica is a rare condition that affects the optic nerve.
Clinical trials
You can explore studies from the Mayo Clinic that investigate new treatments and tests for this condition.
Preparing for your appointment
If you have symptoms suggestive of optic neuritis, such as seeing spots or blurred vision, you will likely see a doctor who is well-versed in diagnosing and treating eye diseases (such as an ophthalmologist or neuro-ophthalmologist).
Here is some information to help you prepare for your appointment.
What you can do
Make a list of:
- Your symptoms, especially vision changes
- Key personal information,The health questionnaire includes any major life changes, such as a recent family death or a serious illness, as well as personal medical history, such as recent infections or other conditions.
- All medications, vitamins, and other supplements must be approved by the FDA before they can be sold. you take, including doses
- Questions to ask your doctor
Make sure to have someone to help you remember the information you are given.
For questions about optic neuritis, you can ask your doctor some questions, including:
- What is likely causing my symptoms?
- Are there other possible causes?
- What tests do I need?
- What treatments do you recommend?
- What are the possible side effects of the medications you're prescribing?
- How long will it take for my vision to improve?
- Will this activity raise my risk of developing multiple sclerosis and if so, what can I do to decrease that risk?
- I have other health conditions. What can I do to best manage them together?
- Can I have brochures or other printed materials? Do you know any websites that I can visit?
What to expect from your doctor
Your doctor may ask you a number of questions, such as:
- How would you describe your symptoms?
- How much has your vision decreased?
- Do colors look less vivid?
- Have your symptoms changed over time?
- Do any changes occur that might make your symptoms better or worse?
- Do you have problems with movement and coordination or numbness or weakness in your arms and legs?