Name
OPTIC NEURITIS
DESCRIPTION
DETAIL
CAUSES β’ Idiopathic β’ Multiple sclerosis β’ Viral infections of childhood (measles, mumps, chickenpox) β’ Other viral infections (mononucleosis, herpes zoster, encephalitis) β’ Contiguous inflammation of the meninges, orbit, or sinuses β’ Granulomatous inflammations (syphilis, tuberculosis, cryptococcus, sarcoidosis) β’ Intraocular inflammations β’ Lead toxicity β’ Chronic high doses chloramphenicol β’ Posterior uveitis β’ Vascular lesions of optic nerve β’ Tumors β’ Fungal infections -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Acute papilledema β’ Anterior ischemic optic neuropathy β’ Severe systemic hypertension β’ Toxic/nutritional optic neuropathy β’ Orbital tumor compressing the optic nerve β’ Intracranial tumor pressing on the afferent visual pathway β’ Leberβs congenital optic neuropathyLABORATORY β’ CBC β’ Antinuclear antibody (ANA) β’ ESR β’ Rapid plasma reagin (RPR) β’ Fluorescent treponemal antibody absorption (FTA-ABS) β’ Serological test for syphilis * FUNDUS EXAMINATION OF EYES SPECIAL TESTS β’ Visual field test (preferably automated Humphrey or Octopus) β’ Color vision testing IMAGING β’ Chest x-ray β’ MRI head or CT head/orbits in atypical cases or when patient is not improving after 10-14 days and other tests are negative DIAGNOSTIC PROCEDURES β’ Check blood pressure β’ Complete ophthalmologic exam including pupillary assessment, color vision evaluation with color plates, dilated retinal examination with optic nerve assessment β’ Neurologic work-up
TYPENOTES
PATIENT EDUCATION β’ Reassurance about recovery of vision β’ If felt to be secondary to demyelinating disease, patient should be informed of the risk of developing multiple sclerosis DRUG(S) OF CHOICE For signifi cant vision loss, corticosteroids may be indicated. These should be administered in conjunction with a neurology consult. ALTERNATIVE DRUGS β’ Pulse steroids: methylprednisolone 250 mg IV q6h x 12 doses in the hospital followed by prednisone 1 mg/kg/day po for 11 days, taper over 1-2 weeks β’ Anti-ulcer medication is given with steroids PATIENT MONITORING Monthly followup to monitor visual changes POSSIBLE COMPLICATIONS Permanent loss of vision EXPECTED COURSE/PROGNOSIS β’ Visual acuity begins to improve 2-3 weeks after onset β’ Improvement continues over several months and vision often returns to normal or near normal levels β’ Those patients with poor vision and who receive IV steroids often recover faster β’ When baseline vision is good, IV steroids have no beneficial effect
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
VDRL, X-RAY CHEST P.A. VIEW( NORMAL ), CT SCAN HEAD, COMPLETE BLOOD COUNT, MRI, BLOOD SUGAR ( RANDOM )