An inflammation of the optic nerve (technically: neuritis nervi optici ; also: retrobulbar neuritis) is an autoimmune inflammation of the optic nerve (optic nerve).
What is optic neuritis?
It often occurs as an early symptom of multiple sclerosis, but also occurs without this underlying disease. After an optic neuritis, a certain degree of optic nerve atrophy may remain with reduced visual acuity. See ablogtophone for MLB which stands for Major League Baseball.
Optic neuritis is an autoimmune inflammation of the second cranial nerve (optic nerve). First, there is damage to the myelin sheaths that electrically insulate the nerve and allow for its high nerve conduction velocity.
As the disease progresses, the actual nerve fibers (axons) are also affected by the inflammation and can perish.
Causes
Optic nerve inflammation is a disease that is still poorly understood. In 70% of cases, their cause remains unexplained. In the remaining 30% of cases, the optic neuritis is an early symptom of multiple sclerosis (MS).
This is a so-called demyelination disease in which the myelin sheaths in the entire central nervous system (CNS) perish due to chronic inflammation. Despite major research efforts, the etiology of MS has not yet been clarified.
Optic neuritis typically manifests itself between the ages of 18 and 45. The incidence is about 3 in 100,000 people. Women are affected three to four times more often than men.
Symptoms, Ailments & Signs
Optic neuritis can manifest itself through a variety of symptoms. The disease first becomes noticeable through increasing eye pain, which is localized behind the eyes and gets worse with eye movements or pressure. The pain is described as dull or throbbing, with the symptoms getting worse as the disease progresses.
In addition, there are visual disturbances, which in the further course can lead to complete blindness. A blind spot develops in the middle of the eye, severely reducing the field of vision. In detail, the visual problems are expressed by the fact that colors are only perceived weakly and blur into each other.
If the neuritis nervi optici is based on multiple sclerosis, vision will be impaired in the long term. In the meantime, vision can improve spontaneously, especially after acute flare-ups. Inflammation of the optic nerve also leads to headaches and dizziness, and occasionally nausea occurs.
The actual inflammation causes general symptoms such as a slight fever and malaise. If the optic neuritis is treated early, the symptoms subside quickly. If left untreated, chronic symptoms can develop and, in extreme cases, blindness in one or both eyes can occur. Typically, only one eye is affected by optic neuritis.
Diagnosis & History
The first symptom of optic neuritis is a rapid onset of visual acuity (loss of vision). The patients see blurred and have e.g. T. slight pain or pressure when moving the eyes.
Headaches and the perception of flashes of light often occur. A temporary worsening of the symptoms with increased body temperature is also typical, e.g. B. in the sauna, in the bathtub or during sports. In extreme cases it can lead to complete blindness. In 7% of cases, the optic neuritis occurs bilaterally. The ophthalmological examination of the fundus may be unremarkable; only in 35% of cases is a swollen papilla visible.
The diagnosis can be confirmed by magnetic resonance imaging (MRI), because demyelination foci can be seen in the MRI. In addition to imaging procedures, CSF diagnostics provide indications of the presence of multiple sclerosis. Electrophysiological recordings can determine a reduced nerve conduction velocity. Otherwise, the optic neuritis is diagnosed solely on the basis of its clinical symptoms and its typical course.
After the rapid onset, the inflammation usually lasts 1-2 weeks and then shows a spontaneous remission. After 5 weeks no further improvement is to be expected. The extent of the remaining damage depends on how much inflammation has already affected the axons of the optic nerve. Because while myelin sheaths can regenerate, axons are usually irreparable.
95% of those affected regain visual acuity of at least 0.5 after healing. 70% even achieve a visual acuity of at least 1.0 again after recovering from an optic neuritis.
Complications
The most dangerous complication of optic neuritis is the complete blindness of the patient. In general, vision deteriorates rapidly when the optic nerves become inflamed. This increases the risk of accidents and falls in everyday life and at work. If the inflammation spreads to other parts of the body, it can lead to infections in the nasopharynx, middle ear infections and, rarely, to skin irritations with itching, swelling and redness.
Further complications depend on the cause of the inflammation. If the symptoms are caused by multiple sclerosis, it will inevitably lead to a loss of vision. A papillit also results in visual impairment, although this is usually less severe. Retrobulbar neuritis sometimes causes severe eye pain and temporary vision problems. Treating optic neuritis also carries risks.
Side effects such as swelling and gastrointestinal problems can occur as part of cortisone therapy. After taking antibiotics and antivirals, various symptoms can occur – including headaches, sore throats, muscle and body aches, reddening of the skin and itching as well as allergic reactions. Prolonged use of these supplements will result in permanent damage to the kidneys, liver, and heart.
When should you go to the doctor?
Optic neuritis should always be evaluated and treated by a doctor. Proper medical treatment is the only way to rule out further complications that could prevent healing. Therefore, a doctor should be consulted at the first signs and symptoms of optic neuritis. A doctor should be consulted if the person concerned suffers from pain in the eyes. In most cases, this pain increases when the person moves their eyes or when the pressure on the eyes increases.
Sudden visual problems also indicate optic neuritis and must also be examined by a doctor if they last for a longer period of time without any particular reason. Many sufferers of optic nerve inflammation also suffer from fever, headaches and nausea. If the optic neuritis is not treated, it can also lead to blindness in the worst case. The disease can be treated relatively well by an ophthalmologist.
Treatment & Therapy
As a rule, an optic neuritis resolves spontaneously without medical intervention. Drug therapy with high-dose steroids can shorten the duration of optic neuritis, but studies have shown that this does not improve the end result, i.e. patients do not retain better visual acuity than without treatment.
Therefore, when talking to the patient, the abbreviation of the disease must be carefully weighed against the side effects of steroid therapy. If at least two foci of demyelination can be seen on the MRI, the administration of high-dose steroids should definitely be offered in order to delay new MS manifestations.
In the case of a so-called atypical inflammation of the optic nerve, which shows no improvement even after 4 weeks, an infectious background must be considered. This is where antibiotics and/or steroids can help. If the optic nerve inflammation is caused by multiple sclerosis, the underlying disease must of course be treated. This is not curable, but can be delayed and alleviated.
Prevention
Since neither optic neuritis nor the multiple sclerosis that often underlies it are fully understood, it is also unknown how this disease can be prevented. However, chronic intoxications with alcohol, tobacco or quinine, various infectious diseases and arterial hypotension are discussed as triggers of the non-MS-related optic neuritis. To prevent optic neuritis, these risk factors should therefore be avoided.
Aftercare
An optic neuritis must be completely cured. Follow-up care by the attending ophthalmologist ensures that the condition has been cured accordingly. First, a patient interview takes place. Here it is clarified whether the patient has any complaints and whether the prescribed medication causes side effects. Depending on the findings, the doctor can take further measures.
The aim of the anamnesis is to obtain as complete an overview as possible of the patient’s state of health. As part of the physical examination, the affected optic nerve is examined visually and, if necessary, examined with other imaging methods. Typical symptoms such as limited vision, but also sensory disturbances must be clarified by the doctor.
Depending on your needs, an eye test can be used for this purpose. Follow-up care is usually provided by the ophthalmologist who has already taken on the treatment of the optic neuritis. If complications arise during follow-up care, other specialists may have to be consulted.
A chronic illness can indicate a viral disease, which must be clarified and treated by an internist. If there are other side effects, neurologists or ENT doctors can be involved in the treatment. Aftercare is based on the severity of the inflammation and the symptoms.
You can do that yourself
An optic neuritis affects the quality of life enormously, since the patients suddenly perceive reduced vision and also suffer from pain in the eye area. Those affected should, in their own interest, help to ensure that the disease heals as quickly as possible. Otherwise, long-term damage to the sense of vision is possible.
First of all, the medication prescribed by the doctor must be taken regularly. In the event of side effects, contact a doctor immediately or go to an emergency practice. Even if there are no complications, it makes sense to have medical check-ups. This allows the doctor to determine the status of the healing process and, if necessary, adjust the dose of the prescribed medication. In addition to taking the medicinal active ingredients, rest and protection play an essential role in accelerating healing. If possible, patients with optic neuritis stay in their own four walls and take bed rest.
Protection is not only important for the immune system, but above all for the sense of sight. Under no circumstances should patients look at screens such as mobile phones or computers. In addition, the eyes must be protected from irritating influences such as wind, strong food vapors, heat, cold and bright light. After consultation with the doctor treating you, an eye patch or sleeping mask can be useful to give the affected eyes enough rest.
