Last reviewed: November 2017
Last updated: December  2016

Summary

Definition

History and exam

Key diagnostic factors

  • periorbital/retro-ocular pain
  • loss of visual acuity with scotoma
  • color desaturation/loss of color vision
  • relative afferent papillary defect (RAPD)

Other diagnostic factors

  • optic disk swelling
  • neurologic abnormalities of multiple sclerosis
  • Uhthoff phenomenon
  • phosphenes
  • Pulfrich phenomenon
  • perivenous sheathing

Risk factors

  • age 30 to 50 years
  • female sex
  • white ethnicity
  • HLA DR(2)15 genetic mutation
  • EBV infection later in childhood
  • childhood in higher latitudes
  • presence of autoimmune disease
  • exposure to infectious diseases, such as Lyme disease and syphilis

Diagnostic investigations

1st investigations to order

  • MRI of the optic nerves
  • CBC
  • ESR
  • C-reactive protein
  • venereal disease research laboratory (VDRL)
  • uric acid
  • serum ACE
  • ANA
Full details

Investigations to consider

  • Lyme titer
  • B12 and folate
  • cerebrospinal fluid analysis
  • neuromyelitis optica (NMO) antibody (aquaporin-4 antibody)
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Chair of Neurology

School of Medical and Surgical Sciences

Division of Stroke Medicine

University of Nottingham

Nottingham

UK

Disclosures

CSC has received research support, support for travel to scientific meetings, or consultancy fees from Biogen, Bayer, Genzyme, Merck, Morphosys, Novartis, Roche, Sanofi-Pasteur, MSD, and Teva. CSC is an author of a number of references cited in this monograph.

Thomas M. Bosley

Professor

Department of Ophthalmology

King Saud University

Riyadh

Saudi Arabia

Professor

Division of Neurology

Cooper University Hospital

University of Medicine and Dentistry of New Jersey

Camden

NJ

Disclosures

TMB declares that he has no competing interests.

Peer reviewers VIEW ALL

Consultant Ophthalmic Surgeon

King's College Hospital

Honorary Research Fellow

Institute of Ophthalmology

London

UK

Disclosures

GG declares that he has no competing interests.

Professor

Department of Neurology and Psychiatry

Saint Louis University

St. Louis

MO

Disclosures

JS declares that he has no competing interests.

Department of Ophthalmology

Geneva University Hospitals

Geneva

Switzerland

Disclosures

EM declares that he has no competing interests.

Specialist Registrar in Ophthalmology

Royal Victoria Infirmary

Newcastle

UK

Disclosures

JS declares that he has no competing interests.

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