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-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
Diagnostic tests
1st tests to order
- 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
Tests to consider
- Lyme titer
- cerebrospinal fluid analysis
Treatment algorithm
acute episode
coexisting inflammatory diseases (e.g., NMOSD, MOGAD, SLE or sarcoidosis)
Contributors
Authors
Cris S. Constantinescu, MD, PhD
Chair of Neurology Emeritus
Academic Unit of Mental Health and Clinical Neuroscience
University of Nottingham
Nottingham
UK
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
MD
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
UK
Divulgaciones
GG declares that he has no competing interests.
John Selhorst, MD
Professor
Department of Neurology and Psychiatry
Saint Louis University
St. Louis
MO
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
UK
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
TX
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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Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
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 DiferencialesGuías de práctica clínica
- Optic neuritis
- Guidelines on diagnosis and management of neuromyelitis optica
Más Guías de práctica clínicaFolletos para el paciente
Lyme disease
Multiple sclerosis
Más Folletos para el paciente
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