A subtype of optic nerve inflammation is referred to as papillitis, in which the optic nerve is damaged in its course on the so-called optic nerve head (papilla). Papillitis causes visual disturbances up to complete loss of vision.
What is papillitis?
In the case of optic nerve inflammation, a distinction is made between different subtypes depending on the localization of the inflammation. One speaks of papillitis when the diseased part of the optic nerve is localized in the eye. The inflammatory reactions manifest themselves in the optic nerve head – the point where the nerve strands of the inner layer of the retina come together and emerge from the eye as the optic nerve. The optic nerve is responsible for transmitting visual information signals to the brain. See gradinmath for What is Quincke’s Edema.
The inflammation-related slowing down of the transmission of information therefore leads to a reduction in vision. Inflammation can also cause permanent damage to the optic nerve. The highest incidence of papillitis is in adults between the ages of 20 and 50. Statistically, women get sick more often than men.
What exactly triggers the inflammation on the optic nerve head cannot be clearly clarified in the majority of cases. Papillitis can be caused by inflammatory diseases, allergies and autoimmune diseases, but also by infections or poisoning. For example, the spread of a focus of inflammation from neighboring anatomical structures, such as the eye socket, the paranasal sinuses or the base of the skull, can lead to papillitis.
In children, inflammation of the optic nerve head usually occurs in connection with an infection of the upper respiratory tract. In adults, on the other hand, it is usually associated with inflammation of the vessel walls (vasculitis) or the brain (encephalitis). Bacterial and viral infections (e.g. spotted fever, syphilis, malaria and diphtheria) can also cause inflammation of the papilla.
Autoimmune diseases such as Crohn’s disease, Wegener ‘s disease or lupus erythematosus are also considered to be triggers. Other causes are metabolic diseases (e.g. diabetes mellitus) and poisoning with methanol, quinine or heavy metals.
Symptoms, Ailments & Signs
Typical symptoms of papillitis are acute visual disturbances. Those affected have reduced visual acuity and a reduced perception of colors and contrasts. Central visual field defects (central scotoma) are also possible. In this quasi – blindness, the space visually captured by the unmoving eye appears in the middle as a black-grey spot.
Usually only one of the two eyes is affected by the inflammation and the associated visual impairment. In addition, patients complain of a painful feeling of pressure in the back of the eyeball. The inflammatory processes can also spread to the locomotor nerves, leading to pain during eye movement.
Painful sensitivity to pressure and light can also occur. The spread of inflammatory pain can also trigger deep-seated headaches. Symptoms can be aggravated by increased body temperature as a result of hot baths, saunas or exercise.
Diagnosis & course of disease
The course of the disease of papillitis varies. As a rule, a reduction in symptoms can be observed as the inflammation heals. Despite medication to speed up the healing process, it can take several weeks to months before you are free of symptoms. Serious inflammation, on the other hand, can lead to permanent visual defects or blindness in the affected eye due to permanent damage to the optic nerve head.
The diagnosis of optic neuritis is generally difficult. The medical history of the patient is clarified in advance. During the clinical examination, the affected eye is inspected. Pain sensitivity can be tested by manually applying pressure to the eyeball. During the ophthalmoscopic examination with the ophthalmoscope, a slightly swollen, blurred and reddened optic nerve head can be seen.
The pupil reaction can be determined using the alternating exposure test. Due to the inflammation, the pupillary reflex of the affected eye is sluggish, which is reflected in a noticeably dilated pupil. In addition, a failure of the central field of vision can be determined as part of the visual field measurement (perimetry).
By deriving visually evoked potentials (VEP), an additional assessment of the optic nerve is carried out. In the case of papillitis, a delayed nerve conduction velocity is revealed. Imaging methods such as magnetic resonance imaging (MRT) or computed tomography (CT) are available for further diagnostics.
A variety of causative factors can be held responsible for inflammation of the bundled optic nerves at their exit point from the eyeball, the papilla. The exact cause of papillitis, as the nerve inflammation is called, is not always identified. The main causes are infections and foci of inflammation in nearby tissues, poisoning, allergies or autoimmune reactions of the immune system. Metabolic diseases such as diabetes mellitus can also trigger papillitis.
Complications that arise as part of papillitis are central visual field defects, which can lead to blindness in the affected eye if the underlying disease that causes it is not treated. In cases in which the underlying disease heals without treatment, the complications of the papillitis also resolve themselves without treatment.
Particular focus is on causative factors such as diabetes mellitus and autoimmune diseases that worsen if left untreated. For example, in type 2 or 1 diabetes, it is extremely important that blood sugar levels are well monitored and controlled to avoid papillitis and damage to the artery and arteriolar walls.
To avoid further complications, the course of autoimmune diseases is also important for targeted therapeutic measures. For example, the degradation of the myelin sheaths of the bundled optic nerves caused by an advanced autoimmune disease is irreversible, so full vision recovery is not possible in this case.
When should you go to the doctor?
Loss of vision is generally a concern. If they persist despite a recovery phase or a balanced night’s sleep, a doctor should be consulted. In many cases, reduced vision can be triggered by overwork or overexertion. Here, after sufficient rest and protection, the normal vision is completely regenerated.
In the event of an acute loss of vision, a doctor should be consulted immediately. A reduced visual acuity as well as a reduced perception of contours or colors should be presented to a doctor. If a black or gray spot can be noticed in the field of vision, this is considered a sign of a disease.
If pain occurs as soon as the eyes are moved, consult a doctor. Sensitivity to light stimuli or light pressure on the eye should be evaluated and treated. A doctor is also required in the event of headaches, an increased risk of falling or accidents, or mental irregularities.
Papillitis is characterized by an increase in symptoms as soon as sports activities are carried out or the person concerned is in an environment with an increased ambient temperature. Sudden loss of vision in a sauna or hot bath should therefore be reported to a doctor immediately. If the behavior shows aggressive tendencies or tearfulness, the cause needs to be clarified.
Treatment & Therapy
The treatment of papillitis is based on the trigger of the inflammatory process. Depending on the respective cause or the underlying primary disease, accompanying neurological or internal measures take place. Drug therapy with anti-inflammatory corticosteroids (e.g. cortisone) accelerates the subsidence of the inflammation and is often indispensable in the case of severe inflammation to prevent long-term damage.
For a high-dose drug treatment with corticosteroids, however, no other diseases such as tuberculosis, stomach ulcers, diabetes mellitus or high blood pressure must be present. The anti-inflammatory drugs are administered orally, but intravenously is also possible in the context of high dosages and for faster effectiveness. Taking cortisone can have side effects and is therefore not without risk, depending on the underlying disease.
Side effects include weight gain, osteoporosis, water retention, and a weakened immune system. If infectious causes are identified as the trigger for the papillitis, the corresponding pathogens are treated with antibiotics or antivirals. In general, the chances of recovery are good if the causes and symptoms of the inflammation are treated quickly. If the therapy is initiated with a delay, however, a longer-lasting inflammation, greater complications and, ultimately, a poorer prognosis must be expected.
Outlook & Forecast
Papillitis offers a relatively good prognosis. Vision often deteriorates gradually, often as a result of an infection, and worsens over a week or two before the condition reaches its nadir. With early treatment, the inflammation of the optic nerve subsides within four to five weeks. However, many patients report persistent problems seeing color and contrast. With the atypical forms, severe visual problems often remain.
If left untreated, papillitis can result in loss of the optic disc. If the optic disc disappears, vision also remains severely restricted. The prospect of recovery is therefore only given with early treatment. Due to the poor eyesight, the quality of life of the patients is limited during the disease. Life expectancy, on the other hand, is not reduced. However, papillitis is often linked to multiple sclerosis, which usually takes a severe course and is associated with other health complications.
The prognosis of papillitis is provided by the ophthalmologist or a neurologist. In addition to the time of diagnosis, the prognosis is also based on the general condition of the patient and the willingness to use various therapeutic methods.
Since the triggers of papillitis remain unexplained in most cases of the disease, there is also no clearly identifiable, effective preventive measure. In the case of corresponding underlying diseases, however, regular ophthalmological check-ups are advisable.
In most cases, those affected with papillitis only have limited direct follow-up measures available. For this reason, early diagnosis of this disease is very important so that further complications can be prevented. Papillitis cannot heal itself, so the affected person can lose sight completely if the disease is not treated in time.
Most patients are dependent on taking various medications that can alleviate and limit the symptoms. The person concerned should always ensure that the dosage is correct and that the medication is taken regularly in order to relieve the symptoms properly and permanently. When taking antibiotics, it should also be noted that they must not be taken together with alcohol.
Regular checks and examinations by a doctor are also very important and can prevent further complications. A direct prediction of the further course of papillitis is usually not possible, as this depends heavily on the time of diagnosis and the severity of the symptoms. In some cases, this disease also reduces the life expectancy of the sufferer.
You can do that yourself
Papillitis is usually treated with cortisone. The patient can support the cortisone therapy by consulting the doctor closely during the therapy and informing him of any side effects. Close monitoring is particularly important when high doses of cortisone are administered, as there is an increased risk of side effects and interactions.
In addition, it is important to protect your eyes. Direct sunlight should be avoided, as should contact with aggressive care products. Patients should ensure adequate sleep and avoid stress. If necessary, the diet must also be changed temporarily. Light food supports the immune system and helps to fight the causative pathogen. If the papillitis is due to an autoimmune disease, further changes must be made. The doctor in charge will usually give the patient the necessary tips and can call in other specialists if necessary.
If, despite all measures, problems arise again, the doctor must be informed. In the case of serious illnesses, all self-help measures should be discussed with the doctor beforehand. The use of alternative remedies is best done in consultation with a specialist.