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Jamali Dogahe S, Pakravan P, Pakravan M. Acute Optic Neuritis: An Update on Approach and Management. JOVR [Internet]. 2023Nov.30 [cited 2024May14];18(4):433–440. Available from: https://knepublishing.com/index.php/JOVR/article/view/14556
https://doi.org/10.18502/jovr.v18i4.14556
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authors
-
Sepideh Jamali Dogahe
Sepideh Jamali Dogahe
Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
-
Parastou Pakravan
Parastou Pakravan
Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
-
Mohammad Pakravan
Mohammad Pakravan
University of Texas Medical Branches, Galveston, TX, USA
Published Date
- Nov 30, 2023
Acute Optic Neuritis: An Update on Approach and Management
Abstract
This review discusses the physical examination and diagnostic tests necessary to diagnose optic neuritis (ON) and provides an update on the approach and management of acute ON. A comprehensive search of the PubMed database was conducted, limited to English-language journals and recent publications. A total of 160 articles were initially screened by title, of which 73 articles were included in the narrative synthesis. ON is an inflammation of the optic nerve that can be caused by different systemic and neurological disorders. It is commonly presented as a subacute unilateral painful vision loss, and based on its clinical manifestation, it can be classified as typical or atypical. Atypical ON is bilateral with visual acuity of worse than 20/200 or has an atypical demographic presentation for demyelination, such as a non-Caucasian male with optic disc swelling, for which neuromyelitis optica spectrum disorder (NMOSD), myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD), or other etiologies should be considered. Steroids and immunosuppressants are the main treatment options for ON, and timely treatment initiation is critical to preventing irreversible vision loss, especially in atypical cases.
Keywords:
MOG, Neuromyelitis optica, Optic neuritis
References
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8. Fortin E, Heller HM, Lyons J, Prasad S. Bilateral optic neuritis from acute HIV infection. Neurol Clin Pract 2019;9:e19–e21.
9. Han SB, Hwang JM, Kim JS, Yang HK. Optic neuritis following Varicella zoster vaccination: Report of two cases. Vaccine 2014;32:4881–4884.
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13. Petzold A, Wattjes MP, Costello F, Flores-Rivera J, Fraser CL, Fujihara K, et al. The investigation of acute optic neuritis: A review and proposed protocol. Nat Rev Neurol 2014;10:447–458.
14. Ng JK, Xie PJ, Saber A, Huxtable J. Assessment of photopsia (flashing lights). BMJ 2023;380:e064767.
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32. Bandettini di Poggio M, Primavera A, Capello E, Bandini F, Mazzarello G, Viscoli C, et al. A case of secondary syphilis presenting as optic neuritis. Neurol Sci 2010;31:365–367.
33. Puech C, Gennai S, Pavese P, Pelloux I, Maurin M, Romanet JP, et al. Ocular manifestations of syphilis: Recent cases over a 2.5-year period. Graefes Arch Clin Exp Ophthalmol 2010;248:1623–1629.
34. Gaier ED, Boudreault K, Rizzo JF 3rd, Falardeau J, Cestari DM. Atypical optic neuritis. Curr Neurol Neurosci Rep 2015;15:76.
35. Levin N, Devereux M, Bick A, Baker N, Green A. Color perception impairment following optic neuritis and its association with retinal atrophy. J Neurol 2019;266:1160– 1166.
36. Tu Y, Jin H, Xu M, Liu W, Hu X, Wang M, et al. Reduced contrast sensitivity function correlated with superficial retinal capillary plexus impairment in early stage of dysthyroid optic neuropathy. Eye Vis (Lond). 2023;10:11.
37. Ristoldo F, You Y, Invernizzi A, Klistorner A, Fraser C. Relationship between Uhthoff phenomenon and demyelination in the visual pathways in multiple sclerosis. Invest Ophthalmol Vis Sci 2019;60:2283.
38. Ambika S, Lakshmi P, Veena Noronha O. Bilateral optic neuritis with spine demyelination associated with influenza A H1N1 infection. Am J Ophthalmol Case Rep 2020;20:101001.
39. Rodriguez-Beato FY, De Jesus O. Compressive optic neuropathy. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2022.
40. Lukewich MK, Micieli JA. Venous stasis retinopathy secondary to myelin-oligodendrocyte glycoprotein antibody-positive optic neuritis. Retin Cases Brief Rep 2022;16:305–307.
41. Aboab J, Errera MH, Espinoza S, Girmens JF, Heron E. Atypical case of MOG antibody-associated optic neuritis with Roth spots. Ocul Immunol Inflamm 2022;1–5.
42. Mittal A, Baig IF, Merchant AG, Chen JJ, Choi JJ, Goldberg A, et al. Sjogren disease and myelin oligodendrocyte glycoprotein antibody-associated optic neuritis. J Neuroophthalmol 2021;41:e48–e50.
43. Liang J, Zhang Y, Liu K, Xu X, Zhao X, Qiu W, et al. Comparing evolvement of visual field defect in neuromyelitis optica spectrum disorder-optic neuritis and idiopathic optic neuritis: A prospective study. BMC Ophthalmol 2022;22:338.
44. Kupersmith MJ, Alban T, Zeiffer B, Lefton D. Contrastenhanced MRI in acute optic neuritis: Relationship to visual performance. Brain 2002;125:812–822.
45. Kitley J, Waters P, Woodhall M, Leite MI, Murchison A, George J, et al. Neuromyelitis optica spectrum disorders with aquaporin-4 and myelin-oligodendrocyte glycoprotein antibodies: A comparative study. JAMA Neurol 2014;71:276–283.
46. Bonhomme GR, Waldman AT, Balcer LJ, Daniels AB, Tennekoon GI, Forman S, et al. Pediatric optic neuritis: Brain MRI abnormalities and risk of multiple sclerosis. Neurology 2009;72:881–885.
47. Swanton JK, Fernando KT, Dalton CM, Miszkiel KA, Altmann DR, Plant GT, et al. Early MRI in optic neuritis: The risk for disability. Neurology 2009;72:542–550.
48. Cellina M, Floridi C, Rosti C, Orsi M, Panzeri M, Pirovano M, et al. MRI of acute optic neuritis (ON) at the first episode: Can we predict the visual outcome and the development of multiple sclerosis (MS)? Radiol Med 2019;124:1296– 1303.
49. Droby A, Panagoulias M, Albrecht P, Reuter E, Duning T, Hildebrandt A, et al. A novel automated segmentation method for retinal layers in OCT images proves retinal degeneration after optic neuritis. Br J Ophthalmol 2016;100:484–490.
50. Xu SC, Kardon RH, Leavitt JA, Flanagan EP, Pittock SJ, Chen JJ. Optical coherence tomography is highly sensitive in detecting prior optic neuritis. Neurology 2019;92:e527– e535.
51. Saidha S, Naismith RT. Optical coherence tomography for diagnosing optic neuritis: Are we there yet? Neurology 2019;92:253–254.
52. Zafeiropoulos P, Katsanos A, Kitsos G, Stefaniotou M, Asproudis I. The contribution of multifocal visual evoked potentials in patients with optic neuritis and multiple sclerosis: A review. Doc Ophthalmol 2021;142:283–292.
53. Filippatou AG, Mukharesh L, Saidha S, Calabresi PA, Sotirchos ES. AQP4-IgG and MOG-IgG related optic neuritis
54. Pache F, Zimmermann H, Mikolajczak J, Schumacher S, Lacheta A, Oertel FC, et al. MOG-IgG in NMO and related disorders: A multicenter study of 50 patients. Part 4: Afferent visual system damage after optic neuritis in MOGIgG- seropositive versus AQP4-IgG-seropositive patients. J Neuroinflammation 2016;13:282.
55. Stiebel-Kalish H, Lotan I, Brody J, Chodick G, Bialer O, Marignier R, et al. Retinal nerve fiber layer may be better preserved in MOG-IgG versus AQP4-IgG optic neuritis: A cohort study. PLoS One 2017;12:e0170847.
56. Azab MA, Hasaneen SF, Hanifa H, Azzam AY. Optic neuritis post-COVID-19 infection. A case report with metaanalysis. Interdiscip Neurosurg 2021;26:101320.
57. Sawalha K, Adeodokun S, Kamoga GR. COVID-19-induced acute bilateral optic neuritis. J Investig Med High Impact Case Rep 2020;8:2324709620976018.
58. François J, Collery AS, Hayek G, Sot M, Zaidi M, Lhuillier L, et al. Coronavirus disease 2019–associated ocular neuropathy with panuveitis: A case report. JAMA Ophthalmol 2021;139:247–249.
59. Azab MA, Hasaneen SF, Hanifa H, Azzam AY. Optic neuritis post-COVID-19 infection. A case report with meta-analysis. Interdiscip Neurosurg 2021;26:101320.
60. Jossy A, Jacob N, Sarkar S, Gokhale T, Kaliaperumal S, Deb AK. COVID-19-associated optic neuritis-A case series and review of literature. Indian J Ophthalmol 2022;70:310–316.
61. Benito-Pascual B, Gegúndez JA, Díaz-Valle D, Arriola- Villalobos P, Carreño E, Culebras E, et al. Panuveitis and optic neuritis as a possible initial presentation of the novel coronavirus disease 2019 (COVID-19). Ocul Immunol Inflamm 2020;28:922–925.
62. Zhou S, Jones-Lopez EC, Soneji DJ, Azevedo CJ, Patel VR. Myelin oligodendrocyte glycoprotein antibody–associated optic neuritis and myelitis in COVID-19. J Neuroophthalmol 2020;40:398–402.
63. Feizi M, R Isen D, Tavakoli M. Neuro-ophthalmic manifestations of coronavirus disease 2019 and its vaccination: A narrative review. J Ophthalmic Vis Res 2023;18:113–122.
64. Wilhelm H, Schabet M. The diagnosis and treatment of optic neuritis. Dtsch Arztebl Int 2015;112:616–625.
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2. Martínez-Lapiscina EH, Fraga-Pumar E, Pastor X, Gómez M, Conesa A, Lozano-Rubí R, et al. Is the incidence of optic neuritis rising? Evidence from an epidemiological study in Barcelona (Spain), 2008–2012. J Neurol 2014;261:759– 767.
3. Yeh EA, Graves JS, Benson LA, Wassmer E, Waldman A. Pediatric optic neuritis. Neurology 2016;87:S53–S58.
4. Akaishi T, Nakashima I, Takeshita T, Kaneko K, Mugikura S, Sato DK, et al. Different etiologies and prognoses of optic neuritis in demyelinating diseases. J Neuroimmunol 2016;299:152–157.
5. Kawachi I. Clinical characteristics of autoimmune optic neuritis. Clin Exp Neuroimmunol 2017;8:8–16.
6. Matsunaga M, Kodama Y, Maruyama S, Miyazono A, Seki S, Tanabe T, et al. Guillain-Barré syndrome and optic neuritis after Mycoplasma pneumoniae infection. Brain Dev. 2018;40:439–442.
7. Jun B, Fraunfelder FW. Atypical optic neuritis after inactivated influenza vaccination. Neuroophthalmology 2017;42:105–108.
8. Fortin E, Heller HM, Lyons J, Prasad S. Bilateral optic neuritis from acute HIV infection. Neurol Clin Pract 2019;9:e19–e21.
9. Han SB, Hwang JM, Kim JS, Yang HK. Optic neuritis following Varicella zoster vaccination: Report of two cases. Vaccine 2014;32:4881–4884.
10. Agarwal A, Garg D, Goyal V, Pandit AK, Srivastava AK, Srivastava MP. Optic neuritis following anti-rabies vaccine. Trop Doct 2020;50:85–86.
11. Petzold A, Fraser CL, Abegg M, Alroughani R, Alshowaeir D, Alvarenga R, et al. Diagnosis and classification of optic neuritis. Lancet Neurol 2022;21:1120–1134.
12. Toosy AT, Mason DF, Miller DH. Optic neuritis. Lancet Neurol 2014;13:83–99.
13. Petzold A, Wattjes MP, Costello F, Flores-Rivera J, Fraser CL, Fujihara K, et al. The investigation of acute optic neuritis: A review and proposed protocol. Nat Rev Neurol 2014;10:447–458.
14. Ng JK, Xie PJ, Saber A, Huxtable J. Assessment of photopsia (flashing lights). BMJ 2023;380:e064767.
15. Storoni M, Pittock SJ, Weinshenker BG, Plant GT. Optic neuritis in an ethnically diverse population: Higher risk of atypical cases in patients of African or African-Caribbean heritage. J Neurol Sci 2012;312:21–25.
16. Moss HE, Gao W, Balcer LJ, Joslin CE. Association of race/ethnicity with visual outcomes following acute optic neuritis: An analysis of the optic neuritis treatment trial. JAMA Ophthalmol 2014;132:421–427.
17. Petzold A, Plant GT. Diagnosis and classification of autoimmune optic neuropathy. Autoimmun Rev 2014;13:539–545.
18. Pirko I, Blauwet LA, Lesnick TG, Weinshenker BG. The natural history of recurrent optic neuritis. Arch Neurol 2004;61:1401–1405.
19. Gise RA, Heidary G. Update on pediatric optic neuritis. Curr Neurol Neurosci Rep 2020;20:4.
20. Yeh EA, Graves JS, Benson LA, Wassmer E, Waldman A. Pediatric optic neuritis. Neurology 2016;87:S53–S58.
21. Wilejto M, Shroff M, Buncic JR, Kennedy J, Goia C, Banwell B. The clinical features, MRI findings, and outcome of optic neuritis in children. Neurology 2006;67:258–262.
22. Zamvil SS, Slavin AJ. Does MOG Ig-positive AQP4- seronegative opticospinal inflammatory disease justify a diagnosis of NMO spectrum disorder? Neurol Neuroimmunol Neuroinflamm 2015;2:e62.
23. Borisow N, Mori M, Kuwabara S, Scheel M, Paul F. Diagnosis and treatment of NMO spectrum disorder and MOG-encephalomyelitis. Front Neurol 2018;9:888.
24. Petzold A, Plant GT. Chronic relapsing inflammatory optic neuropathy: A systematic review of 122 cases reported. J Neurol 2014;261:17–26.
25. Sève P, Jamilloux Y, Tilikete C, Gerfaud-Valentin M, Kodjikian L, El Jammal T. Ocular sarcoidosis. Seminars in Respiratory and Critical Care Medicine 2020;41:673–688.
26. Groen F, Rothova A. Ocular involvement in sarcoidosis. Seminars in Respiratory and Critical Care Medicine 2017;38:514–522.
27. Baughman RP, Weiss KL, Golnik KC. Neuro-ophthalmic sarcoidosis. Eye Brain 2012;4:13–25.
28. Webb LM, Chen JJ, Aksamit AJ, Bhattacharyya S, Chwalisz BK, Balaban D, et al. A multi-center case series of sarcoid optic neuropathy. J Neurol Sci 2021;420:117282.
29. Gupta V, Shoughy SS, Mahajan S, Khairallah M, Rosenbaum JT, Curi A, et al. Clinics of ocular tuberculosis. Ocul Immunol Inflamm 2015;23:14–24.
30. Jaafar J, Hitam WH, Noor RA. Bilateral atypical optic neuritis associated with tuberculosis in an immunocompromised patient. Asian Pac J Trop Biomed 2012;2:586–588.
31. Zayet S, Zaghdoudi A, Harrabi H, Goubantini A, Tiouiri Benaissa H. Devic’s neuromyelitis optica associated with active pulmonary tuberculosis, Tunisia. New Microbes New Infect. 2020;39:100828.
32. Bandettini di Poggio M, Primavera A, Capello E, Bandini F, Mazzarello G, Viscoli C, et al. A case of secondary syphilis presenting as optic neuritis. Neurol Sci 2010;31:365–367.
33. Puech C, Gennai S, Pavese P, Pelloux I, Maurin M, Romanet JP, et al. Ocular manifestations of syphilis: Recent cases over a 2.5-year period. Graefes Arch Clin Exp Ophthalmol 2010;248:1623–1629.
34. Gaier ED, Boudreault K, Rizzo JF 3rd, Falardeau J, Cestari DM. Atypical optic neuritis. Curr Neurol Neurosci Rep 2015;15:76.
35. Levin N, Devereux M, Bick A, Baker N, Green A. Color perception impairment following optic neuritis and its association with retinal atrophy. J Neurol 2019;266:1160– 1166.
36. Tu Y, Jin H, Xu M, Liu W, Hu X, Wang M, et al. Reduced contrast sensitivity function correlated with superficial retinal capillary plexus impairment in early stage of dysthyroid optic neuropathy. Eye Vis (Lond). 2023;10:11.
37. Ristoldo F, You Y, Invernizzi A, Klistorner A, Fraser C. Relationship between Uhthoff phenomenon and demyelination in the visual pathways in multiple sclerosis. Invest Ophthalmol Vis Sci 2019;60:2283.
38. Ambika S, Lakshmi P, Veena Noronha O. Bilateral optic neuritis with spine demyelination associated with influenza A H1N1 infection. Am J Ophthalmol Case Rep 2020;20:101001.
39. Rodriguez-Beato FY, De Jesus O. Compressive optic neuropathy. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2022.
40. Lukewich MK, Micieli JA. Venous stasis retinopathy secondary to myelin-oligodendrocyte glycoprotein antibody-positive optic neuritis. Retin Cases Brief Rep 2022;16:305–307.
41. Aboab J, Errera MH, Espinoza S, Girmens JF, Heron E. Atypical case of MOG antibody-associated optic neuritis with Roth spots. Ocul Immunol Inflamm 2022;1–5.
42. Mittal A, Baig IF, Merchant AG, Chen JJ, Choi JJ, Goldberg A, et al. Sjogren disease and myelin oligodendrocyte glycoprotein antibody-associated optic neuritis. J Neuroophthalmol 2021;41:e48–e50.
43. Liang J, Zhang Y, Liu K, Xu X, Zhao X, Qiu W, et al. Comparing evolvement of visual field defect in neuromyelitis optica spectrum disorder-optic neuritis and idiopathic optic neuritis: A prospective study. BMC Ophthalmol 2022;22:338.
44. Kupersmith MJ, Alban T, Zeiffer B, Lefton D. Contrastenhanced MRI in acute optic neuritis: Relationship to visual performance. Brain 2002;125:812–822.
45. Kitley J, Waters P, Woodhall M, Leite MI, Murchison A, George J, et al. Neuromyelitis optica spectrum disorders with aquaporin-4 and myelin-oligodendrocyte glycoprotein antibodies: A comparative study. JAMA Neurol 2014;71:276–283.
46. Bonhomme GR, Waldman AT, Balcer LJ, Daniels AB, Tennekoon GI, Forman S, et al. Pediatric optic neuritis: Brain MRI abnormalities and risk of multiple sclerosis. Neurology 2009;72:881–885.
47. Swanton JK, Fernando KT, Dalton CM, Miszkiel KA, Altmann DR, Plant GT, et al. Early MRI in optic neuritis: The risk for disability. Neurology 2009;72:542–550.
48. Cellina M, Floridi C, Rosti C, Orsi M, Panzeri M, Pirovano M, et al. MRI of acute optic neuritis (ON) at the first episode: Can we predict the visual outcome and the development of multiple sclerosis (MS)? Radiol Med 2019;124:1296– 1303.
49. Droby A, Panagoulias M, Albrecht P, Reuter E, Duning T, Hildebrandt A, et al. A novel automated segmentation method for retinal layers in OCT images proves retinal degeneration after optic neuritis. Br J Ophthalmol 2016;100:484–490.
50. Xu SC, Kardon RH, Leavitt JA, Flanagan EP, Pittock SJ, Chen JJ. Optical coherence tomography is highly sensitive in detecting prior optic neuritis. Neurology 2019;92:e527– e535.
51. Saidha S, Naismith RT. Optical coherence tomography for diagnosing optic neuritis: Are we there yet? Neurology 2019;92:253–254.
52. Zafeiropoulos P, Katsanos A, Kitsos G, Stefaniotou M, Asproudis I. The contribution of multifocal visual evoked potentials in patients with optic neuritis and multiple sclerosis: A review. Doc Ophthalmol 2021;142:283–292.
53. Filippatou AG, Mukharesh L, Saidha S, Calabresi PA, Sotirchos ES. AQP4-IgG and MOG-IgG related optic neuritis
54. Pache F, Zimmermann H, Mikolajczak J, Schumacher S, Lacheta A, Oertel FC, et al. MOG-IgG in NMO and related disorders: A multicenter study of 50 patients. Part 4: Afferent visual system damage after optic neuritis in MOGIgG- seropositive versus AQP4-IgG-seropositive patients. J Neuroinflammation 2016;13:282.
55. Stiebel-Kalish H, Lotan I, Brody J, Chodick G, Bialer O, Marignier R, et al. Retinal nerve fiber layer may be better preserved in MOG-IgG versus AQP4-IgG optic neuritis: A cohort study. PLoS One 2017;12:e0170847.
56. Azab MA, Hasaneen SF, Hanifa H, Azzam AY. Optic neuritis post-COVID-19 infection. A case report with metaanalysis. Interdiscip Neurosurg 2021;26:101320.
57. Sawalha K, Adeodokun S, Kamoga GR. COVID-19-induced acute bilateral optic neuritis. J Investig Med High Impact Case Rep 2020;8:2324709620976018.
58. François J, Collery AS, Hayek G, Sot M, Zaidi M, Lhuillier L, et al. Coronavirus disease 2019–associated ocular neuropathy with panuveitis: A case report. JAMA Ophthalmol 2021;139:247–249.
59. Azab MA, Hasaneen SF, Hanifa H, Azzam AY. Optic neuritis post-COVID-19 infection. A case report with meta-analysis. Interdiscip Neurosurg 2021;26:101320.
60. Jossy A, Jacob N, Sarkar S, Gokhale T, Kaliaperumal S, Deb AK. COVID-19-associated optic neuritis-A case series and review of literature. Indian J Ophthalmol 2022;70:310–316.
61. Benito-Pascual B, Gegúndez JA, Díaz-Valle D, Arriola- Villalobos P, Carreño E, Culebras E, et al. Panuveitis and optic neuritis as a possible initial presentation of the novel coronavirus disease 2019 (COVID-19). Ocul Immunol Inflamm 2020;28:922–925.
62. Zhou S, Jones-Lopez EC, Soneji DJ, Azevedo CJ, Patel VR. Myelin oligodendrocyte glycoprotein antibody–associated optic neuritis and myelitis in COVID-19. J Neuroophthalmol 2020;40:398–402.
63. Feizi M, R Isen D, Tavakoli M. Neuro-ophthalmic manifestations of coronavirus disease 2019 and its vaccination: A narrative review. J Ophthalmic Vis Res 2023;18:113–122.
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