Fact-sheet: Optic neuritis


Updated on 03/07/2025 at 11:48 AM

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Definition

Inflammatory involvement of the posterior optic nerve:
orbital, apical, cisternal, and prechiasmatic segments; more rarely involving the chiasm and optic tracts.

By far the most common etiology is multiple sclerosis

Non-infectious etiologies:

  • Multiple sclerosis
  • Neuromyelitis optica spectrum disorder (NMOSD)
  • MOG antibody-associated disease (MOGAD)
  • Anti-CRMP-5 optic neuropathy
  • Autoimmune GFAP astrocytopathy
  • Neurosarcoidosis
  • Acute disseminated encephalomyelitis
  • Chronic relapsing inflammatory optic neuropathy
  • Lupus
  • Sjögren's syndrome
  • Behçet's disease

Infectious etiologies:

  • Lyme disease
  • Toxoplasmosis
  • HIV
  • HSV
  • VZV

Clinical features

  • Orbital pain exacerbated by eye movements (90%)
  • Sudden unilateral visual acuity loss of variable severity (up to no light perception)
  • Relative afferent pupillary defect = Marcus Gunn pupil
  • Red/green dyschromatopsia
  • Rapidly progressive central or cecocentral scotoma
  • VEP: increased latency / decreased conduction velocity.
  • Central/cecocentral scotoma
  • Normal fundus exam or mild papilledema in late-stage disease

MRI

Acute phase:

  • T2 hyperintensity of the optic nerve, associated with edema and swelling of the nerve in its intraorbital segment, at the posterior aspect of the globe.
  • Optic nerve enhancement in 90% of cases within the first 20 days, well visualized on contrast-enhanced fat-saturated T1-weighted coronal sequences.

Chronic phase:

  • T2 hyperintensity may persist permanently and be associated with residual optic nerve atrophy.

Management

Treatment of the underlying condition.
Corticosteroid therapy

Differential diagnosis

Optic nerve sheath meningioma

Optic pathway glioma

Optic perineuritis