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Optic Neuritis (cont.)

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What are signs of optic neuritis?

The most characteristic findings on examination include reduced visual acuity (typically 20/25 to 20/200), a measurable change in peripheral vision, decreased perception of brightness in the affected eye, and loss of color vision out of proportion to the loss of visual acuity. A disturbance in reaction of the pupil (afferent pupillary defect or APD) is usually detectable if the other eye is either unaffected or involved to a lesser degree.

The optic nerve head can easily be visualized with an ophthalmoscope. In one-third of the cases, there is visible swelling of the optic nerve head, and there may be enlargement of the blood vessels around the nerve. This condition is called papillitis. In about two-thirds of patients, the inflammation is entirely behind the eye (retrobulbar), causing no visible changes when the physician examines the optic nerve with an ophthalmoscope. This is called retrobulbar neuritis.

What types of doctors treat optic neuritis?

An ophthalmologist is a medical doctor who specializes in the diagnosis and treatment of eye disease. Ophthalmologists diagnose and treat optic neuritis, often in conjunction with a neurologist or family physician. A neuro-ophthalmologist is a medical doctor who subspecializes in the connections between the eye and the brain. Other specialists are involved based on any underlying diseases.

How do health care professionals diagnose optic neuritis?

Optic neuritis is suspected based on the characteristic history of eye pain and vision loss. The standard exam includes visual acuity, pupillary reduction, visual field evaluation, color vision testing, and visualization of the optic disc by direct and indirect ophthalmoscopy.

A person experiencing a first episode of optic neuritis should undergo an MRI of the brain to detect central nervous system lesions associated with MS. If there is active brain inflammation, single or multiple brain lesions may be seen which light up (enhance) with injection of contrast material. The MRI may also show an enlarged optic nerve or inflamed optic nerve sheath.

Visual symptoms usually progress for the first few weeks and then start to improve within the first month. If the course of recovery is not typical, further testing can be performed to look for more unusual causes of optic neuritis/neuropathy.

Medically Reviewed by a Doctor on 10/31/2017


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