Multipe Sclerosis - Related Disorders

Optic Neuritis - updated: 10 November 2009

Optic neuritis--more than a loss of vision

Aust Fam Physician. 2009 Oct;38(10):789-93.

Chu ER, Chen CS.

BACKGROUND: Optic neuritis is an acute inflammation of the optic nerve that results in painful loss of vision. Patients often present to a general practitioner, and early recognition is important as treatment may improve the speed of vision recovery. OBJECTIVE: This article provides information on the signs and symptoms of optic neuritis and discusses appropriate referral, investigations and management. DISCUSSION: Optic neuritis is the presenting symptom in up to one-fifth of people with multiple sclerosis. Diagnosis of optic neuritis is based on history and examination, therefore obtaining pertinent information and performing proper ophthalmic examination is essential. Prompt recognition and appropriate referral is important to facilitate investigations such as magnetic resonance imaging of the brain that can help predict risk in the development of multiple sclerosis.

Publication Types:

• Review

Optic neuritis in multiple sclerosis

Ocul Immunol Inflamm. 2002 Sep;10(3):161-86.

Chan JW.

PURPOSE: To review the clinical features, natural history, potential pathogenic mechanisms, differential diagnosis, and management of optic neuritis in multiple sclerosis. METHODS: Relevant literature regarding optic neuritis in multiple sclerosis from 1970 to the present was reviewed. RESULTS: Optic neuritis is an acute inflammatory optic neuropathy. It is the most common type of optic neuropathy causing acute visual loss in young adults (peak age at 30-40 years), especially among women. Patients usually present with an acute reduction of visual acuity, orbital pain exacerbated by eye movements, dyschromatopsia, and an afferent papillary defect, with or without swelling of the optic nerve head. Visual field testing most often reveals central defects, but others, such as centrocecal, can also occur. Magnetic resonance image (MRI) scanning of the brain should be undertaken in all cases of acute optic neuritis for diagnostic and prognostic purposes. The brain lesions of multiple sclerosis are commonly seen as T2 ovoid high-signal white matter lesions on MRI scans of the brain located in perivenular regions perpendicular to ventricles with variable enhancement. For atypical presentations of optic neuritis, additional laboratory tests, such as cerebrospinal fluid analysis, serologic tests, and visual evoked potentials, prove to be useful in the diagnosis and subsequent management of the patient. The recommended treatment for optic neuritis is intravenous steroids, as shown in the Optic Neuritis Treatment Trial (ONTT). CONCLUSION: Optic neuritis is often the initial presentation of multiple sclerosis. Recent advances in the understanding of the immune basis for multiple sclerosis has led to earlier and more effective treatment of this disease.

Publication Types:

• Review

Progressive changes in the retinal nerve fiber layer in patients with multiple sclerosis

Eur J Ophthalmol. 2009 Sep 30.

Garcia-Martin E, Pueyo V, Martin J, Almarcegui C, Ara JR, Dolz I, Honrubia FM, Fernandez FJ.

Purpose. To quantify changes in the retinal nerve fiber layer (RNFL) of patients with multiple sclerosis (MS) over a 1-year time period and to compare the ability of noninvasive diagnostic imaging devices and visual evoked potentials (VEP) to detect axonal loss in these patients. Methods. Eighty-one patients with MS underwent a complete ophthalmic examination that included assessment of visual acuity and color vision, refractive evaluation, visual field examination, optical coherence tomography (OCT), scanning laser polarimetry (GDx), and measurement of VEP. All the patients were re-evaluated after a period of 12 months in order to quantify any change in the RNFL. Only one randomly chosen eye from each patient was included in the study. Results. Statistically significant differences between the 2 examinations were recorded for the overall mean and inferior RNFL thickness and the macular volume, as assessed by OCT, as well as for the temporal-superior-nasal-inferior-temporal average standard deviation provided by GDx. The greatest differences were obtained for the mean RNFL thickness (90.46 microm vs 85.96 microm). Changes in the optic nerve were detected by structural measurements but not by functional assessments. Conclusions. Axonal loss in the optic nerve of patients with MS is greater than that expected in healthy subjects, regardless of the presence of a previous optic neuritis.

Publication Types:

• Review

Publication Types:

• Review