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Neurite óptica

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 20 Aug 2025
Last updated: 06 Jun 2024

Summary

Definition

History and exam

Key diagnostic factors

  • dor periorbital/retro-ocular
  • perda da acuidade visual com escotoma
  • dessaturação das cores/perda da visão das cores
  • defeito pupilar aferente relativo (DPAR)
Full details

Other diagnostic factors

  • edema do disco óptico
  • anormalidades neurológicas da esclerose múltipla
  • fosfenos
  • fenômeno de Uhthoff
  • fenômeno de Pulfrich
  • revestimento perivenoso
Full details

Risk factors

  • idade entre 30 e 50 anos
  • sexo feminino
  • etnia branca
  • genótipo HLA-DRB1*1501
  • fatores de risco para esclerose múltipla (EM; infecção pelo vírus Epstein-Barr [EBV], deficiência de vitamina D e tabagismo)
  • infância em latitudes mais altas
  • presença de doença autoimune
  • exposição a doenças infecciosas, como doença de Lyme e sífilis
Full details

Diagnostic investigations

1st investigations to order

  • ressonância nuclear magnética (RNM) - cranioencefálica
  • Hemograma completo
  • Velocidade de hemossedimentação (VHS)
  • proteína C-reativa
  • Venereal Disease Research Laboratory (VDRL)
  • anticorpo anti-aquaporina 4 (AQP4), anticorpo anti-glicoproteína mielina-oligodendrócito (MOG) e anticorpo anti-proteína-5 mediadora da resposta à colapsina (CRMP5)
  • ácido úrico
  • enzima conversora da angiotensina (ECA) sérica
  • fator antinuclear (FAN)
  • dosagem de vitamina B12 e folato
Full details

Investigations to consider

  • título de Lyme
  • análise do líquido cefalorraquidiano
Full details

Treatment algorithm

ACUTE

episódio agudo

ONGOING

doenças inflamatórias coexistentes (por exemplo, NMOSD, MOGAD, LES ou sarcoidose)

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

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
Thomas M. Bosley

Knights Templar Eye Foundation Professor of Ophthalmology

Wilmer Eye Institute

Johns Hopkins University

Baltimore

MD

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

UK

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

MO

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

UK

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

TX

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.
  • Neurite óptica images

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    • Guidelines on diagnosis and management of neuromyelitis optica
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