optic neuritis

Optic nerve inflammation: description

In optic neuritis (neuritis nervi optici), the optic nerve is inflamed, which allows us to see. He leaves the retina (retina) on the so-called papilla in the direction of the brain and leads there the signals that arise from the light on the retina.

The optic nerve can be inflamed both near the papilla and later. If the Neuritis nervi optici on the papilla, one speaks of a papillitis or atypical optic nerve inflammation. A typical optic nerve inflammation is the so-called retrobulbar neuritis, in which the inflammatory process is behind the eye.

Every year about one to six people in 100,000 develop retrobulbar neuritis. The disease occurs mainly in young women between 20 and 40 years. Only every fifth patient is male. The frequency of typical optic nerve inflammation increases from the equator to the poles. The disease is closely linked to the occurrence of multiple sclerosis (MS).

Papillitis, or atypical optic nerve inflammation, usually affects children or older people over the age of 50 years. Patients often suffered from a viral upper respiratory tract infection just before.

Optic nerve inflammation: symptoms

Optic nerve inflammation leads primarily to a reduction in vision. The vision deteriorates drastically within a few hours or days. The visual acuity decreases significantly, especially in the central area of ​​the visual field. The godfathers report seeing them through frosted glass or through a gray veil. In addition, they feel a dull pain in the eye, which is mainly triggered by eye movements.

If there is a typical optic nerve inflammation, the color saturation may be impaired. This applies above all to the color red. In addition, the so-called Uthoff phenomenon can occur. This means that the symptoms of optic nerve inflammation increase with heat. For example, when patients take a hot bath, they notice a deterioration in their vision. About 30 percent of patients with optic nerve inflammation perceive flashes of light.

Optic nerve inflammation: causes and risk factors

The causes of optic nerve inflammation are manifold. A typical optic nerve inflammation occurs especially in multiple sclerosis. In this disease, in which the immune system is directed against the body’s own structures (autoimmune disease), the so-called myelin sheaths of the nerves are attacked. They surround the nerve endings (axons) and thus allow a high conduction velocity of the information. If the myelin sheath is damaged, this affects the transmission of the nerve signals. Other autoimmune diseases such as sarcoidosis or lupus erythematosus can cause optic nerve inflammation.

The myelin sheaths can not be attacked only by autoimmune processes. Also infections with certain pathogens can damage the nerve conduction. This often causes papillitis in children after a cold. But even infections that directly affect the nervous system, such as Lyme disease or syphilis, can cause optic nerve inflammation.

Optic nerve inflammation: examinations and diagnosis

In order to diagnose “optic nerve inflammation”, your doctor will first ask you in detail about the history of the disease (anamnesis). He will ask you the following questions:

• When did your vision deteriorate?
• Pain eye movements?
• Is seeing worse on one side than on the other?
• Have you had a cold or have you had a fever recently?
• Do you suffer from cardiovascular disease?
• Did a family member of yours already have similar symptoms?
• Is a case of multiple sclerosis known in your family?
• Are you dizzy or have you noticed weaknesses in your muscles?
• Do you smoke, drink alcohol or take medications regularly?
• Are the symptoms of heat stronger (for example if you take a bath)?
• Are you aware of flashes of light?

Optic nerve inflammation: determination of visual acuity

Then your doctor examines your eyes. Using a letter or number plate your visual acuity is determined. It is reduced in an optic nerve inflammation.

Optic nerve inflammation: test of the pupillary reaction

After that, your doctor lights up alternately with a small lamp in your eyes and watches the reaction of your pupils. Normally, both pupils narrow equally, no matter which eye the doctor is pointing at the cone of light. In retrobulbar neuritis, however, there is often a so-called relative afferent pupillary defect (RAPD). This means that the optic nerve of the affected eye does not conduct the incoming light signals as well into the brain as the other optic nerve. As a result, the pupils contract less when the doctor directs the light to the diseased eye, and stronger when he shines into the healthy eye.

Optic nerve inflammation: examination of eye mobility

In addition, the doctor checks the mobility of your eyes. For this purpose, you should say, for example, follow his finger or a pen exclusively with the look, whether the movements hurt you or you see doubles.

Optic nerve inflammation: determination of the visual field

Next, your field of vision is tested. This is the area of ​​the environment that your eyes can see without your head moving. The visual field can be roughly checked with the fingers of the examiner. You must say so as soon as you see the finger in your field of vision.

With a so-called perimeter, the visual field examination can be carried out more accurately. There are different points of light blinking that you should recognize in your field of vision. In optic nerve inflammation there is often a limitation of the visual field in the central area (central scotoma).

Optic nerve inflammation: examination of the fundus

Subsequently, the doctor reflects your fundus (fundoscopy). For this he lights up with an ophthalmoscope in your eyes. So he can judge the retina. He pays attention, inter alia, to changes in the blood vessels and the place where the optic nerve leaves the eye (papilla). In retrobulbar neuritis fundoscopy is usually inconspicuous. Only in about 30 percent of cases is the papilla changed. In atypical optic neuritis, the papilla is red and swollen.

Optic nerve inflammation: examination of color perception

In addition, your color perception will be tested. In a typical neuritis nervi optici especially the color saturation for red is weakened.

Optic nerve inflammation: test of optic nerve conduction

Visually evoked potentials (VEPs) can be used to check the conduction velocity of the optic nerve. With this method of measurement, electrodes are attached to your head. After the irritation of your optic nerve by showing images, the electrodes are used to measure which signals and how fast they arrive via the optic nerve in the brain. In an inflammation of the optic nerve, they are often changed.

Optic nerve inflammation: advanced diagnostics

If your doctor has determined whether it is a typical or atypical optic nerve inflammation, further investigations are carried out. With their help one wants to find out, which illness caused the optic nerve inflammation.

In a typical neuritis nervi optici that first appeared, the patient develops multiple sclerosis (MS) in about 30 percent of cases over the next five years. To diagnose them, a magnetic resonance imaging (MRI) of the head and spine are made. In addition, a lumbar puncture is performed: a sample of cerebrospinal fluid (CSF) is taken from the lumbar spine and examined for signs of inflammation that may be indicative of MS.

Atypical optic nerve inflammation can cause other diseases. Therefore, blood is often taken to examine for various pathogens or antibodies.

Optic nerve inflammation: differentiation against other diseases

The doctor must also check if there is no other illness that causes symptoms similar to optic nerve inflammation. These include, among other things, the papilledema. It arises when the intracranial pressure increases. It causes similar signs of disease, but does not usually limit vision to the same extent as optic neuritis.

A poisoning with alcohol, for example, can be like an optic nerve inflammation. As a rule, it always occurs on both sides.

Other eye diseases, such as anterior ischemic optic neuropathy (AION), which is common in diabetes mellitus, and Leber’s hereditary optic neuropathy (LHON) must be distinguished from optic nerve inflammation.

Optic nerve inflammation: treatment

The therapy of optic nerve inflammation depends on the cause of the disease.

If retrobulbar neuritis is present and further diagnosis is likely to lead to multiple sclerosis, drugs that suppress the immune system (immunosuppressants) are used. These include glucocorticoids (steroids) such as cortisone or methylprednisolone. They are given in very high doses for the first three to five days, which are then slowly reduced over two weeks. Before such therapy with high-dose cortisone is carried out, diseases such as tuberculosis, gastric ulcers, diabetes mellitus or high blood pressure must first be excluded. These can worsen with a glucocorticoid therapy. Subsequently, the MS is treated with special drugs such as interferon beta or glatiramer acetate.

If a bacterial infection is the cause of optic nerve inflammation, antibiotics may be used for the treatment. But also steroids may be useful in the treatment to stop an excessive immune response.

Basically, for patients with optic nerve inflammation: protection and bed rest. In this way, you can do something yourself to reduce the duration and severity of the disease in an optic nerve inflammation.

Optic nerve inflammation: disease course and prognosis

With regard to the course and prognosis of optic nerve inflammation, a distinction must be made between retrobulbar neuritis and papillitis. Basically, a weekly check should be performed by the doctor during the first three weeks. Thereafter, the time interval of the controls is to be selected individually.

Optic nerve inflammation: course and prognosis of retrobulbar neuritis

Retrobulbar neuritis worsens the vision of patients within a few hours to days. After about one to two weeks, the low point of the disease is reached. Thereafter, healing is also spontaneously possible without any intervention from the medical side. After five weeks, however, an improvement in visual acuity is no longer to be expected. Seventy percent of patients regain full vision after the first appearance of typical optic neuritis, and more than 90 percent of them achieve visual acuity greater than 0.5, provided they are above 0.5 before inflammation. After optic nerve inflammation both optic nerves can fall ill again.

If demyelinating herds are on MRI for the first time, the likelihood of developing multiple sclerosis (MS) over the next five years is between 35 and 50 percent.

Optic nerve inflammation: course and prognosis of papillitis

A papillitis is rather creeping. Often, it occurs after an upper respiratory tract infection. It does not improve on its own within four weeks. If therapy is not initiated in time, the optic disc may disappear over the course of time. As a result of optic neuritis then your eyesight can be limited.