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Retrobulbar Optic NeuropathyAka: Optic Neuritis

Causes
1. Encephalomyelitis
2. Posterior Uveitis
3. Optic Nerve vascular lesions
4. Tumor
  1. Optic Nerve glioma
  2. Neurofibromatosis
  3. Meningioma
5. Fungal infections
6. Medications
  1. Aminosalicylic acid
  2. Chloramphenicol
  3. Ethambutol
  4. Isoniazid
  5. Penicillamine
  6. Phenothiazines
  7. Phenylbutazone
  8. Quinine
  9. Streptomycin
Associated Conditions
1. Multiple Sclerosis
Epidemiology
1. Young patients predominate
Symptoms
1. Pain behind affected eye is variably present
2. 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. Optic disc
  1. Normal or
  2. Optic Nerve pallor or papillitis present
2. Pupil light reflex abnormal
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

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/16/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.