Optic neuritis: Difference between revisions
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*Pain (esp w/ eye movement) | *Pain (esp w/ eye movement) | ||
*Loss of color vision out of proportion to loss of visual acuity | *Loss of color vision out of proportion to loss of visual acuity | ||
* | *Pulfrich effect - swing object side to side like pendulum, but pt feels like the object is coming at them in elliptical fashion; suggestive of demyelination | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 03:17, 2 February 2016
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
- 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
- Pulfrich effect - swing object side to side like pendulum, but pt feels like the object is coming at them in elliptical fashion; suggestive of demyelination
Differential Diagnosis
Acute Vision Loss (Noninflamed)
- Painful
- Arteritic anterior ischemic optic neuropathy
- Optic neuritis
- Temporal arteritis†
- Painless
- Amaurosis fugax
- Central retinal artery occlusion (CRAO)†
- Central retinal vein occlusion (CRVO)†
- High altitude retinopathy
- Open-angle glaucoma
- Posterior reversible encephalopathy syndrome (PRES)
- Retinal detachment†
- Stroke†
- Vitreous hemorrhage
- Traumatic optic neuropathy (although may have pain from the trauma)
†Emergent Diagnosis
Diagnosis
Physical Exam
- 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
- Intraocular pressures
- Afferent Pupilary Defect (APD)
- Optic disc swelling and edema (papillitis)
- Elevated optic nerve disk on US = papilledema
Work-up
- MRI of brain and orbits with gadolinium, plus fat suppression
- CBC
- CMP
- ESR, CRP
- RPR, FTABS
- CXR
- May consider LP to r/o neuromyelitis optica
Disposition
- Consult neuro and ophthalmology
- Inpatient admission for IV methylprednisolone, 1 g qd x3 days