Learn about this painful eye disorder that affects your optic nerve and what your doctor may recommend for treatment.
Optic neuritis occurs when swelling (inflammation) damages the optic nerve — a bundle of nerve fibers that transmits visual information from your eye to your brain. Common symptoms of optic neuritis include pain with eye movement and temporary vision loss in one eye.
Signs and symptoms of optic neuritis can be the first indication of multiple sclerosis (MS), or they can occur later in the course of MS. MS is a disease that causes inflammation and damage to nerves in your brain as well as the optic nerve.
Besides MS, optic nerve inflammation can occur with other conditions, including infections or immune diseases, such as lupus. Rarely, another disease called neuromyelitis optica causes inflammation of the optic nerve and spinal cord.
Most people who have a single episode of optic neuritis eventually recover their vision without treatment. Sometimes steroid medications may speed the recovery of vision after optic neuritis.
The optic nerve is a bundle of nerve fibers that serves as the communication cable between your eyes and your brain. The nerve fibers have a special coating called myelin.
Optic neuritis usually affects one eye. Symptoms might include:
Eye conditions can be serious. Some can lead to permanent vision loss, and some are associated with other serious medical problems. Contact your doctor if:
The exact cause of optic neuritis is unknown. It's believed to develop when the immune system mistakenly targets the substance covering your optic nerve, resulting in inflammation and damage to the myelin.
Normally, the myelin helps electrical impulses travel quickly from the eye to the brain, where they're converted into visual information. Optic neuritis disrupts this process, affecting vision.
The following autoimmune conditions often are associated with optic neuritis:
Multiple sclerosis. Multiple sclerosis is a disease in which your autoimmune system attacks the myelin sheath covering nerve fibers in your brain. In people with optic neuritis, the risk of developing multiple sclerosis after one episode of optic neuritis is about 50% over a lifetime.
Your risk of developing multiple sclerosis after optic neuritis increases further if an MRI scan shows lesions on your brain.
When symptoms of optic neuritis are more complex, other associated causes need to be considered, including:
Risk factors for developing optic neuritis include:
Complications arising from optic neuritis may include:
You're likely to see an ophthalmologist for a diagnosis, which is generally based on your medical history and an exam. The ophthalmologist likely will perform the following eye tests:
Other tests to diagnose optic neuritis might include:
Magnetic resonance imaging (MRI). An MRI scan uses a magnetic field and pulses of radio wave energy to make pictures of your body. During an MRI to check for optic neuritis, you might receive an injection of a contrast solution to make the optic nerve and other parts of your brain more visible on the images.
An MRI is important to determine whether there are damaged areas (lesions) in your brain. Such lesions indicate a high risk of developing multiple sclerosis. An MRI can also rule out other causes of visual loss, such as a tumor.
Your doctor is likely to ask you to return for follow-up exams two to four weeks after your symptoms begin to confirm the diagnosis of optic neuritis.
Optic neuritis usually improves on its own. In some cases, steroid medications are used to reduce inflammation in the optic nerve. Possible side effects from steroid treatment include weight gain, mood changes, facial flushing, stomach upset and insomnia.
Steroid treatment is usually given by vein (intravenously). Intravenous steroid therapy quickens vision recovery, but it doesn't appear to affect the amount of vision you'll recover for typical optic neuritis.
When steroid therapy fails and severe vision loss persists, a treatment called plasma exchange therapy might help some people recover their vision. Studies haven't yet confirmed that plasma exchange therapy is effective for optic neuritis.
If you have optic neuritis, and you have two or more brain lesions evident on MRI scans, you might benefit from multiple sclerosis medications, such as interferon beta-1a or interferon beta-1b, that may delay or help prevent MS. These injectable medications are used for people at high risk of developing MS. Possible side effects include depression, injection site irritation and flu-like symptoms.
Most people regain close to normal vision within six months after an optic neuritis episode.
People whose optic neuritis returns have a greater risk of developing MS, neuromyelitis optica or MOG antibody associated disorder. Optic neuritis can recur in people without underlying conditions, and those people generally have a better long-term prognosis for their vision than do people with MS or neuromyelitis optica.
If you have signs and symptoms of optic neuritis, you'll likely see your family doctor or a doctor who specializes in diagnosing and treating eye diseases (ophthalmologist or neuro-ophthalmologist).
Here's some information to help you get ready for your appointment.
Make a list of:
Take a family member or friend along, if possible, to help you remember the information you're given.
For optic neuritis, questions to ask your doctor include:
Your doctor is likely to ask you a number of questions, such as: