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Retrobulbar Optic Neuropathy
Aka: Retrobulbar Optic Neuropathy, Optic Neuritis, Papillitis
- See Also
- Multiple Sclerosis
- Epidemiology
- Young patients predominate (esp. age 20 to 45 years old)
- Pathophysiology
- Immune-mediated inflammatory demyelination of the Optic Nerve
- Demyelination results in Retinal Ganglion cell axon degeneration
- Causes
- Multiple Sclerosis
- Encephalomyelitis
- Posterior Uveitis
- Optic Nerve vascular lesions
- Central Retinal Artery Occlusion
- Central Retinal Vein Occlusion
- Anterior Ischemic Optic Neuropathy
- Tumor
- Optic Nerve glioma
- Neurofibromatosis
- Meningioma
- Fungal infections
- Medications
- Aminosalicylic acid
- Chloramphenicol
- Ethambutol
- Isoniazid
- Penicillamine
- Phenothiazines
- Phenylbutazone
- Quinine
- Streptomycin
- Risk Factors
- Multiple Sclerosis
- White Race
- Female Gender
- Age 20 to 45 years old
- Associated Conditions
- Multiple Sclerosis
- Optic Neuritis is the presenting finding in 15-20% of Multiple Sclerosis (overal seen in 50% of MS cases)
- Symptoms
- Pain behind affected eye is variably present
- Worse with eye movement
- Central Vision Loss
- Loss of color vision
- Impaired vision develops over hours to days
- Affects one or both eyes
- Rarely results in total blindness
- Acuity often worse than 20/100
- Signs
- Unilateral optic disc swelling and blurring of the disc margin
- Optic Nerve pallor, hyperemia or Papillitis present (Papilledema)
- Optic disc may appear normal in Retrobulbar Optic Neuropathy
- Pupil light reflex abnormal
- Afferent Pupillary Defect
- Provocative maneuvers
- Extraocular Movement painful
- Pressure on globe painful
- Decreased Visual Acuity amd Visual Field deficits
- Labs: Cerebrospinal Fluid
- WBC: Normal or 10-20 WBC present
- Oligoclonal bands may be present
- Imaging
- Brain MRI and Orbit MRI with gadolinium contrast
- Confirm acute demyelinating Optic Neuritis
- Identify concurrent CNS findings suggestive of Multiple Sclerosis (e.g. periventricular white matter deficits)
- Management
- Hospital admit
- IV Glucocorticoids
- Methylprednisolone 250 mg IV every 6 hours for 3 days
- Reduces chance of future MS
- Course
- 30-50% develop Multiple Sclerosis within 15 years
- References
- Yanoff (1999) Ophthalmology, Mosby, p. 6.2-6.4