Neuro

Retrobulbar Optic Neuropathy

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Retrobulbar Optic Neuropathy, Optic Neuritis

  • Causes
  1. Multiple Sclerosis
  2. Encephalomyelitis
  3. Posterior Uveitis
  4. Optic Nerve vascular lesions
    1. Central Retinal Artery Occlusion
    2. Central Retinal Vein Occlusion
    3. Anterior Ischemic Optic Neuropathy
  5. Tumor
    1. Optic Nerve glioma
    2. Neurofibromatosis
    3. Meningioma
  6. Fungal infections
  7. Medications
    1. Aminosalicylic acid
    2. Chloramphenicol
    3. Ethambutol
    4. Isoniazid
    5. Penicillamine
    6. Phenothiazines
    7. Phenylbutazone
    8. Quinine
    9. Streptomycin
  • Associated Conditions
  • Epidemiology
  1. Young patients predominate
  • Symptoms
  1. Pain behind affected eye is variably present
    1. Worse with eye movement
  2. Central Vision Loss
  3. Loss of color vision
  4. Impaired vision develops over hours to days
    1. Affects one or both eyes
    2. Rarely results in total blindness
    3. Acuity often worse than 20/100
  • Signs
  1. Unilateral optic disc swelling
    1. Normal or
    2. Optic Nerve pallor or papillitis present (Papilledema)
  2. Pupil light reflex abnormal
    1. Afferent Pupillary Defect
  3. Provocative maneuvers
    1. Extraocular Movement painful
    2. Pressure on globe painful
  • Labs
  • Cerebrospinal Fluid
  1. WBC: Normal or 10-20 WBC present
  2. Oligoclonal bands may be present
  • Management
  1. Hospital admit
  2. IV Glucocorticoids
    1. Reduces chance of future MS
  • Course
  1. 30-50% develop Multiple Sclerosis within 15 years
  • References
  1. Yanoff (1999) Ophthalmology, Mosby, p. 6.2-6.4