Optic neuritis: Difference between revisions
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Inflammatory, demyelinating condition of the optic nerve highly associated with MS | |||
**50% will go on to develop MS | |||
*Presenting feature of MS in 15-20% of pts | |||
==Causes== | ===Causes=== | ||
*Idiopathic | |||
*[[Multiple sclerosis]] | |||
*Postchildhood vaccination | |||
*Viral infection | |||
**Measles, mumps, varicella, zoster, EBV | |||
*Inflammation of structures contiguous with the optic nerve | |||
**Meninges, orbit, sinuses | |||
*Other infections | |||
**[[Syphilis]], [[Tuberculosis]], Crypto | |||
*[[Sarcoidosis]], uveitis | |||
*[[Temporal arteritis]] | |||
*Vasculitides | |||
*Ischemic optic neuropathy | |||
*Hypertensive retinopathy, papilledema | |||
*DM retinopathy | |||
*Intracranial tumor, orbital tumor | |||
*Glaucoma | |||
==Clinical Features== | ==Clinical Features== | ||
*Acute, usually monocular, vision loss occurring over days (occasionally over hours) | |||
**May range from mildly reduced to no light perception whatsoever | |||
*Retro-orbital headache | |||
*Pain (esp w/ eye movement) | |||
*Loss of color vision out of proportion to loss of visual acuity | |||
==Differential Diagnosis== | |||
==Diagnosis== | ==Diagnosis== | ||
*Red desaturation test | |||
**Have pt look with one eye at a dark red object | |||
**Test the other eye to see if the object looks the same color | |||
***Affected eye often will see the red object as pink or lighter red | |||
*Ocular pressures | |||
*Afferent Pupilary Defect (APD) | |||
*Optic disc swelling and edema (papillitis) | |||
**Elevated optic nerve disk on US = papilledema | |||
*MRI of brain and orbits with gadolinium, plus fat suppression | |||
*CBC | |||
*CMP | |||
*ESR, CRP | |||
*RPR, FTABS | |||
*CXR | |||
==Disposition== | ==Disposition== | ||
*Consult neuro and ophthalmology | |||
*Inpatient admission for IV methylprednisolone, 1 g qd x3 days | |||
==See Also== | ==See Also== | ||
[[Multiple Sclerosis (MS)]] | *[[Multiple Sclerosis (MS)]] | ||
== | ==References== | ||
*Ergene et al. Adult Optic Neuritis. Mar 19 2014. http://emedicine.medscape.com/article/1217083-overview. | *Ergene et al. Adult Optic Neuritis. Mar 19 2014. http://emedicine.medscape.com/article/1217083-overview. | ||
*Gerstenblith AT and Rabinowitz MP. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. Lippincott Wolter (2012). | *Gerstenblith AT and Rabinowitz MP. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. Lippincott Wolter (2012). | ||
Revision as of 15:37, 1 September 2015
Background
- Inflammatory, demyelinating condition of the optic nerve highly associated with MS
- 50% will go on to develop MS
- Presenting feature of MS in 15-20% of pts
Causes
- Idiopathic
- Multiple sclerosis
- Postchildhood vaccination
- Viral infection
- Measles, mumps, varicella, zoster, EBV
- Inflammation of structures contiguous with the optic nerve
- Meninges, orbit, sinuses
- Other infections
- Syphilis, Tuberculosis, Crypto
- Sarcoidosis, uveitis
- Temporal arteritis
- Vasculitides
- Ischemic optic neuropathy
- Hypertensive retinopathy, papilledema
- DM retinopathy
- Intracranial tumor, orbital tumor
- Glaucoma
Clinical Features
- Acute, usually monocular, vision loss occurring over days (occasionally over hours)
- May range from mildly reduced to no light perception whatsoever
- Retro-orbital headache
- Pain (esp w/ eye movement)
- Loss of color vision out of proportion to loss of visual acuity
Differential Diagnosis
Diagnosis
- Red desaturation test
- Have pt look with one eye at a dark red object
- Test the other eye to see if the object looks the same color
- Affected eye often will see the red object as pink or lighter red
- Ocular pressures
- Afferent Pupilary Defect (APD)
- Optic disc swelling and edema (papillitis)
- Elevated optic nerve disk on US = papilledema
- MRI of brain and orbits with gadolinium, plus fat suppression
- CBC
- CMP
- ESR, CRP
- RPR, FTABS
- CXR
Disposition
- Consult neuro and ophthalmology
- Inpatient admission for IV methylprednisolone, 1 g qd x3 days
See Also
References
- Ergene et al. Adult Optic Neuritis. Mar 19 2014. http://emedicine.medscape.com/article/1217083-overview.
- Gerstenblith AT and Rabinowitz MP. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. Lippincott Wolter (2012).