Optic neuritis

Optic neuritis is an inflammation of the optic nerve which can cause severe pressure, pain and headaches and may result in the destruction of the protective myelin sheath that covers the optic nerve. These conditions are usually the result of an autoimmune reaction or disorder in which the body mistakes its own oligodendrocytes for a pathogen and essentially attacks them.

Any time the myelin sheath has been destroyed or severely compromised, the nerve is susceptible to direct damage. Optic neuropathy is a general term used to describe any conditions that result in damage to the optic nerve. Symptoms would include blurred vision in only one eye, double vision, difficulty in coordination and fatigue. Benign tumors can also form in the optic nerve sheath and cause these side effects. Tumor growth may compress the optic nerve and cause loss of vision in the affected eye.

Research has been conducted for many years to develop techniques for detecting these issues early on and repairing the myelin sheaths. One option to patients might be the surgical implanting of oligodendrocyte precursor cells. Other times, the condition is so progressed or acute that there may not be a cure, only medications and treatments to deal with pain or slow the condition's progress.

Classic clinical findings of multiple sclerosis are optic neuritis, paresthesias, INO and bladder symptoms.

The percentage of patients with an attack of optic neuritis and no prior attack that will go on to develop MS ranges from 17–87%, depending on the series 1).

see neuromyelitis optica

Nitrofurantoin (Macrodantin®): may cause optic neuritis.

Papilledema may appear similar to optic neuritis on funduscopy, but the latter is usually associated with more severe visual loss and tenderness to eye pressure over the eye.

Early bevacizumab therapy in steroid refractory radiation induced optic neuritis (RION) shows gratifying results 2).

In a patient-physician perspective article, Braithwaite et al. shared the story of a patient affected by an autoimmune disease that attacks the nerves connecting the eyes and the brain and reflects back physicians’ perspectives on the disease and the patient’s experience of it. In a compelling account, we gain some understanding of what it might be like to live with the fear of unpredictable episodes of sudden, recurrent sight loss and the important impacts that this has on a patient’s life and mental wellbeing. We recognize that the outcome metrics that physicians usually focus on, such as measurement of vision and imaging of the optic nerve, do not fully capture the outcomes that most matter to the patient. We explore patient-reported outcome measures that go some way towards bridging this gap. Finally, we consider the technological advances that will make more comprehensive capture of the patient experience reality in future clinical practice and research, supporting both patients and physicians to optimize shared care 3).

Rowland LP. Merritt's Textbook of Neurology. Philadelphia 1989
Dutta P, Dhandapani S, Kumar N, Gupta P, Ahuja C, Mukherjee KK. Bevacizumab for radiation associated visual decline among aggressive residual/recurrent suprasellar tumors: More than a mere anti-neoplastic effect. World Neurosurg. 2017 Jul 25. pii: S1878-8750(17)31211-1. doi: 10.1016/j.wneu.2017.07.111. [Epub ahead of print] PubMed PMID: 28754639.
Braithwaite T, Wiegerinck N, Petzold A, Denniston A. Vision Loss from Atypical Optic Neuritis: Patient and Physician Perspectives. Ophthalmol Ther. 2020 Mar 21. doi: 10.1007/s40123-020-00247-9. [Epub ahead of print] PubMed PMID: 32200476.
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  • Last modified: 2020/03/24 00:39
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