Optic neuritis: Difference between revisions
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==Background==
==Background==
#an inflammatory, demyelinating condition highly associated with multiple sclerosis (MS)
#Inflammatory, demyelinating condition of the optic nerve highly associated with MS
#presenting feature of MS in 15 to 20 percent of patients and occurs in 50 percent at some time during the course of their illness
##50% will go on to develop MS
#Presenting feature of MS in 15-20% of pts
 
==Causes==
#Idiopathic
#MS
#Postchildhood vaccination
#Viral infection
##Measles, mumps, varicella, zoster, EBV
#Inflammation of structures contiguous with the optic nerve
##Meninges, orbit, sinuses
#Other infections
##Syphilis, TB, Crypto
 
==Clinical Features==
#Acute, usually monocular, vision loss occurring over days (occasionally over hours)
##May range from mildly reduced to no light perception whatsoever
#Pain (esp w/ eye movement)
#Loss of color vision out of proportion to loss of visual acuity


==Diagnosis==
==Diagnosis==
#acute, usually monocular, visual loss-usually monocular (90%)
#Red desaturation test
#vision loss (over hours to days; peaking within 1-2 wks)
##Have pt look with one eye at a dark red object
#eye pain (92%), often worsened with eye movement
##Test the other eye to see if the object looks the same color
#afferent pupillary defect
###Affected eye often will see the red object as pink or lighter red
#visual field defect (typically central scotoma)
#APD
#papillitis (33%) with hyperemia and swelling of the disk, blurring of disk margins, and distended veins
#Optic disc swelling and edema (papillitis)
#photopsias (30%) (flickering or flashes of light) often precipitated with eye movement
#MRI
#loss of color of vision out of proportion to the loss of visual acuity is specific
 
==Work-Up==
Insert


==DDx==
==DDx==
Insert
#Ischemic optic neuropathy
#Papilledema
#Hypertensive retinopathy
#Orbital tumor compressing optic nerve
#Intracranial tumor compressing visual pathway


==Treatment==
==Treatment==
Insert
#Consult neuro and ophtho
 
#IV methylprednisolone
==Disposition==
Insert


==See Also==
==See Also==
Line 29: Line 45:


==Source==
==Source==
KajiQuestions
Tintinalli


[[Category:Neuro]]
[[Category:Neuro]]
[[Category:Ophtho]]
[[Category:Ophtho]]

Revision as of 20:12, 28 October 2011

Background

  1. Inflammatory, demyelinating condition of the optic nerve highly associated with MS
    1. 50% will go on to develop MS
  2. Presenting feature of MS in 15-20% of pts

Causes

  1. Idiopathic
  2. MS
  3. Postchildhood vaccination
  4. Viral infection
    1. Measles, mumps, varicella, zoster, EBV
  5. Inflammation of structures contiguous with the optic nerve
    1. Meninges, orbit, sinuses
  6. Other infections
    1. Syphilis, TB, Crypto

Clinical Features

  1. Acute, usually monocular, vision loss occurring over days (occasionally over hours)
    1. May range from mildly reduced to no light perception whatsoever
  2. Pain (esp w/ eye movement)
  3. Loss of color vision out of proportion to loss of visual acuity

Diagnosis

  1. Red desaturation test
    1. Have pt look with one eye at a dark red object
    2. Test the other eye to see if the object looks the same color
      1. Affected eye often will see the red object as pink or lighter red
  2. APD
  3. Optic disc swelling and edema (papillitis)
  4. MRI

DDx

  1. Ischemic optic neuropathy
  2. Papilledema
  3. Hypertensive retinopathy
  4. Orbital tumor compressing optic nerve
  5. Intracranial tumor compressing visual pathway

Treatment

  1. Consult neuro and ophtho
  2. IV methylprednisolone

See Also

Multiple Sclerosis (MS)

Source

Tintinalli

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