Optic neuritis

Descripción general 
Teoría 
Diagnóstico 
Manejo 
Seguimiento 
Recursos 

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Última revisión: 22 Sep 2025

Última actualización: 06 Jun 2024

Optic neuritis (ON) may involve the retrobulbar (retrobulbar neuritis) or the intrabulbar (papillitis) portion of the optic nerve, or both.

Idiopathic ON, the most common form of ON, is an inflammatory optic neuropathy in the absence of evidence of a systemic inflammatory disease.

May occur in isolation or be a manifestation, often the first, of multiple sclerosis (MS).

Investigations including MRI of the brain can help predict the risk of conversion to MS and can dictate early intervention with disease-modifying treatments (interferon-beta, glatiramer acetate) that reduces the risk of conversion to MS.

Acute treatment for idiopathic ON includes high-dose oral or intravenous corticosteroid treatment.

Low-to-medium dose oral corticosteroids alone should not be used in the treatment of idiopathic acute ON.

Definición

ON represents inflammation of the optic nerve. By far the most common form is idiopathic ON, which is a primary demyelinating disease occurring in isolation or as part of MS.[1][2] When in isolation, primary demyelinating ON is considered a forme fruste of MS. ON manifests as the subacute or acute onset of pain in the eye and pain with eye movements and loss of vision, typically with central or centrocecal scotoma that usually reaches a nadir at approximately 1-2 weeks. ON recovers over several months, with ultimate visual acuity that is possibly reduced but seldom severely so.

Anamnesis y examen

Principales factores de diagnóstico

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

Todos los datos

Otros factores de diagnóstico

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

Todos los datos

Factores de riesgo

age 30 to 50 years
female sex
white ethnicity
HLA-DRB1*1501 genotype
risk factors for multiple sclerosis (MS; Epstein-Barr virus [EBV] infection, vitamin D deficiency, and smoking)
childhood in higher latitudes
presence of autoimmune disease
exposure to infectious diseases, such as Lyme disease and syphilis

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

MRI - brain
CBC
ESR
C-reactive protein
venereal disease research laboratory (VDRL)
aquaporin-4 (AQP4) antibody, myelin oligodendrocyte glycoprotein (MOG) antibody, and collapsin response mediator protein 5 (CRMP5) antibody
uric acid
serum ACE
ANA
B12 and folate

Todos los datos

Pruebas diagnósticas que deben considerarse

Lyme titer
cerebrospinal fluid analysis

Todos los datos

Algoritmo de tratamiento

Agudo

acute episode

En curso

coexisting inflammatory diseases (e.g., NMOSD, MOGAD, SLE or sarcoidosis)

Colaboradores

Autores

Cris S. Constantinescu, MD, PhD

Chair of Neurology Emeritus

Academic Unit of Mental Health and Clinical Neuroscience

University of Nottingham

Nottingham

Attending Neurologist

Professor of Neurology

Cooper Neuroscience Institute

Camden

New Jersey

Divulgaciones

CSC has received research support or consultancy fees from Biogen, GW, Merck, Morphosys, Novartis, Roche, Sanofi-Pasteur, MSD, and Teva. CSC is an author of a number of references cited in this topic.

Thomas M. Bosley, MD

Knights Templar Eye Foundation Professor of Ophthalmology

Wilmer Eye Institute

Johns Hopkins University

Baltimore

Divulgaciones

TMB declares that he has no competing interests.

Revisores por pares

Gus Gazzard, MA, MBBChir, MD, FRCOphth

Consultant Ophthalmic Surgeon

King's College Hospital

Honorary Research Fellow

Institute of Ophthalmology

London

Divulgaciones

GG declares that he has no competing interests.

John Selhorst, MD

Professor

Department of Neurology and Psychiatry

Saint Louis University

St. Louis

Divulgaciones

JS declares that he has no competing interests.

Efstratios Mendrinos, MD

Department of Ophthalmology

Geneva University Hospitals

Geneva

Switzerland

Divulgaciones

EM declares that he has no competing interests.

Jonathan Smith, MD

Specialist Registrar in Ophthalmology

Royal Victoria Infirmary

Newcastle

Divulgaciones

JS declares that he has no competing interests.

Peter Sguigna, MD

Assistant Professor

Department of Neurology

The University of Texas

Southwestern Medical Center

Dallas

Divulgaciones

PS has received grant support from National Multiple Sclerosis Society, International Progressive Multiple Sclerosis Alliance, National Institute of Health (NIH), Center for Translational Medicine, Physician Scientist Training Program, and Department of Defense (DOD). He has received research support from Genentech, Clene Nanomedicine, and Patient Centered Outcomes Research Institute. He has received consulting fees from Medical Logix LLC, Genentech, EMD Serono, Horizon Therapeutics, and Bristol Myers Squibb. He is the inventor on a patent for OCT technology that is held by UT Southwestern Medical Center.

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Referencias

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Artículos principales

Petzold A, Fraser CL, Abegg M, et al. Diagnosis and classification of optic neuritis. Lancet Neurol. 2022 Dec;21(12):1120-34. Resumen

American Academy of Ophthalmology. Optic neuritis - 2012. Jul 2012 [internet publication].Texto completo

Beck RW, Cleary PA, Anderson MM Jr, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group. N Engl J Med. 1992 Feb 27;326(9):581-8. Resumen

Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018 Feb;17(2):162-73.Texto completo Resumen

Sellner J, Boggild M, Clanet M, et al. EFNS guidelines on diagnosis and management of neuromyelitis optica. Eur J Neurol. 2010 Aug;17(8):1019-32.Texto completo Resumen

Gal RL, Vedula SS, Beck R. Corticosteroids for treating optic neuritis. Cochrane Database Syst Rev. 2015 Aug 14;(8):CD001430.Texto completo Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales
- Lyme disease
- Syphilis
- HIV infection
Más Diferenciales
Guías de práctica clínica
- Optic neuritis
- Guidelines on diagnosis and management of neuromyelitis optica
Más Guías de práctica clínica
Folletos para el paciente
Lyme disease
Multiple sclerosis
Más Folletos para el paciente
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Optic neuritis

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

acute episode

coexisting inflammatory diseases (e.g., NMOSD, MOGAD, SLE or sarcoidosis)

Colaboradores

Autores

Cris S. Constantinescu, MD, PhD

Divulgaciones

Thomas M. Bosley, MD

Divulgaciones

Revisores por pares

Gus Gazzard, MA, MBBChir, MD, FRCOphth

Divulgaciones

John Selhorst, MD

Divulgaciones

Efstratios Mendrinos, MD

Divulgaciones

Jonathan Smith, MD

Divulgaciones

Peter Sguigna, MD

Divulgaciones

Agradecimiento de los revisores por pares

Divulgaciones

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guías de práctica clínica

Folletos para el paciente

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión para acceder a todo el BMJ Best Practice