Optic neuritis

მიმოხილვა 
თეორია 
დიაგნოზი 
მართვა 
მეთვალყურეობა 
წყაროები 

最后审阅： 16 Jan 2026

最后更新： 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.

定义

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.

病史和体格检查

关键诊断因素

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

完整详情

其他诊断因素

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

完整详情

危险因素

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

完整详情

诊断性检查

首要检查

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

完整详情

需考虑的检查

Lyme titer
cerebrospinal fluid analysis

完整详情

治疗流程

急症处理

acute episode

持续性治疗

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

撰稿人

作者

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

利益声明

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

利益声明

TMB declares that he has no competing interests.

同行评议者

Gus Gazzard, MA, MBBChir, MD, FRCOphth

Consultant Ophthalmic Surgeon

King's College Hospital

Honorary Research Fellow

Institute of Ophthalmology

London

利益声明

GG declares that he has no competing interests.

John Selhorst, MD

Professor

Department of Neurology and Psychiatry

Saint Louis University

St. Louis

利益声明

JS declares that he has no competing interests.

Efstratios Mendrinos, MD

Department of Ophthalmology

Geneva University Hospitals

Geneva

Switzerland

利益声明

EM declares that he has no competing interests.

Jonathan Smith, MD

Specialist Registrar in Ophthalmology

Royal Victoria Infirmary

Newcastle

利益声明

JS declares that he has no competing interests.

Peter Sguigna, MD

Assistant Professor

Department of Neurology

The University of Texas

Southwestern Medical Center

Dallas

利益声明

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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

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

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

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. 摘要

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.全文摘要

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.全文摘要

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

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断
- Lyme disease
- Syphilis
- HIV infection
更多鉴别诊断
指南
- Optic neuritis
- Guidelines on diagnosis and management of neuromyelitis optica
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患者教育信息
Lyme disease
Multiple sclerosis
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Optic neuritis

小结

定义

病史和体格检查

关键诊断因素

其他诊断因素

危险因素

诊断性检查

首要检查

需考虑的检查

治疗流程

acute episode

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

撰稿人

作者

Cris S. Constantinescu, MD, PhD

利益声明

Thomas M. Bosley, MD

利益声明

同行评议者

Gus Gazzard, MA, MBBChir, MD, FRCOphth

利益声明

John Selhorst, MD

利益声明

Efstratios Mendrinos, MD

利益声明

Jonathan Smith, MD

利益声明

Peter Sguigna, MD

利益声明

Peer reviewer acknowledgements

Disclosures

参考文献

关键文献

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断

指南

患者教育信息

登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

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