BACKGROUND‐Optic neuritis is one of the most common neuro‐ophthalmologic diseases that neurologists encounter in their practice. This inflammatory optic neuropathy may occur as an isolated entity or as the initial manifestation of multiple sclerosis. In addition to the well‐defined clinical syndrome of optic neuritis, the cause is becoming more well understood and the management of this disorder is constantly improving.REVIEW SUMMARY‐The important clinical aspects of optic neuritis are detailed for the clinician, which includes an outline of diagnostic pitfalls and appropriate laboratory tests to be ordered. The natural history of optic neuritis is described to give an understanding of the prognosis and outcome of this disease. Furthermore, new findings in the pathogenesis of multiple sclerosis and current treatment recommendations are presented.CONCLUSIONS‐Optic neuritis is an acute inflammatory optic neuropathy. It is the most common type of optic neuropathy causing acute visual loss in young adults (peak age at 30 to 40 years), especially among women. Patients usually present with acute reduced visual acuity, pain exacerbated by eye movements, dyschromatopsia, an afferent pupil defect, and swelling of the optic nerve head. Visual field testing often reveals central, centrocecal, arcuate, altitudinal, or nasal step defects. Magnetic resonance image scanning of the brain should be ordered in all cases of acute optic neuritis for diagnostic and prognostic purposes. The brain lesions of multiple sclerosis are commonly seen as T2 ovoid high‐signal white matter lesions on magnetic resonance image scans of the brain located in perivenular regions perpendicular to ventricles with variable enhancement. Other laboratory tests, such as cerebrospinal fluid analysis, serologic tests, and visual evoked potentials, add little to the workup of typical optic neuritis. For atypical presentations of optic neuritis, such tests prove to be useful in the diagnosis and treatment of the patient. The recommended treatment for optic neuritis is intravenous steroids. Other promising therapies include intravenous &ggr;‐globulin and some interferons, but studies so far have not resulted in any new treatment guidelines.(THE NEUROLOGIST 6:205‐213, 2000)
展开▼
