Optic
Neuritis (Papillitis) Introduction: Optic neuritis
(also known medically as "papillitis") is an inflammation of the optic
nerve head that is visible with the ophthalmoscope as a yellow disc. It usually
presents on one eye only. Most commonly it is seen with multiple
sclerosis, where it is due to demyelination of the optic nerve. However,
temporal arteritis that is associated with polymyalgia
rheumatica can also lead to an acute inflammation of the optic disc
(optic neuritis). There are many other illnesses that can cause optic neuritis
as is outlined in this more
detailed ophthalmological text.
Signs
and symptoms: There is visual loss on one eye that can present
as a blind spot or that involves eventually all of the visual field of the affected
eye. Blindness can develop rapidly within 1 or 2 days. The physician notices that
the pupillary reflex to light of the affected eye is missing or quite weak. There
is no pain associated with this, quite in contrast with retrobulbar neuritis,
where pain is prominent. Diagnostic test: Using
the ophthalmoscope the eye specialist sees swelling
(=edema) of the optic disc and increased size of the blood vessels
(=hyperemia) in an early stage. Later
there is more inflammation and there can even be some bleeding form
leaking blood vessels. An MRI
scan in the case of a multiple sclerosis patient may show that there
is demyelination of one optic nerve with the other one being normal (seen on the
image of this link as a lack of the central white line that is present on the
other side). Treatment: Treatment is directed against
the underlying cause. In the case of multiple sclerosis it has been shown in this
study and others that early
interferon treatment can make a difference in some patients.
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