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Tuesday

 

What You Need to Know About Optic Neuritis
























Optic neuritis may go away on its own in a few weeks, or sooner with treatment. Getty Images

Commonly associated with MS, this inflammation of the optic nerve can cause pain and temporary vision loss.

You owe your vision, in large part, to your optic nerve. It carries messages from your eyes to your brain, which interprets them. But if the optic nerve becomes swollen and inflamed, a condition called optic neuritis, you can experience pain and interruption of vision.

Optic neuritis is often the first symptom of multiple sclerosis (MS), says Michael Racke, MD, a professor and chair of the neurology department at The Ohio State University College of Medicine in Columbus. That’s because the optic nerve is part of the central nervous system (CNS) and is often the first area of the CNS to come under attack by MS.

Symptoms and Diagnosis

Most commonly, people get optic neuritis in one eye, but both eyes can be affected. Often, the first indication is pain: Optic neuritis hurts.

“The fact that there is inflammation with optic neuritis tends to make it painful,” Dr. Racke says. “Most people with optic neuritis notice there is something wrong, and it’s typically pain with eye movement.”

Optic neuritis can also cause temporary loss of vision that can last for a few hours or a few weeks. Eye pain or loss of vision typically sends people to their eye doctor.

“If we suspect optic neuritis with a high degree of certainty, we will send the patient to see a neurologist and get [a magnetic resonance imaging (MRI) scan] to check for MS,” says Houman Vosoghi, MD, an ophthalmologist at the Amerisight Institute and Valley Eye Center in Van Nuys, California.

Both ophthalmologists and neurologists can diagnose optic neuritis.

Not everyone who has optic neuritis goes on to develop MS, but an MRI can help assess your risk. Brain abnormalities visible at the time of the optic neuritis attack are a strong predictor of MS, the Multiple Sclerosis Foundation states, adding that this awareness can lead to a discussion with your healthcare team about using disease-modifying drugs to reduce the risk of MS or its severity.

Optic neuritis may go away on its own in a few weeks, or sooner with treatment. “Your vision will recover faster if you are given IV steroids,” Dr. Vosoghi says.

Oral steroids, however, shouldn't be used: A landmark study published in The New England Journal of Medicine in February 1992 not only showed that oral steroids did not improve optic neuritis, but it also showed that they placed those who used them at a greater risk for future attacks.

More recently, a Cochrane Database of Systemic Reviews report published online in August 2015 confirmed that IV steroids did lead to a quicker return to normal vision, but they don't eliminate the possibility of some slight changes in vision.

"You may have some lingering effects, such as a lesser ability to distinguish colors, and may actually see better in dim versus bright light," Racke says.

Incidence and Recurrence

About 50 percent of people who have MS experience a bout of optic neuritis at least once, according to The Transverse Myelitis Association. As with MS itself, women are more susceptible to optic neuritis than men.

Recurrences of optic neuritis are not uncommon, but why it recurs in some people and not others is not known — and when it might recur for any one person is unpredictable.

Marni Blake Ellis, 33, of Brooklyn, New York, has had three episodes of optic neuritis in the 10-plus years since she was diagnosed with MS. It was her first MS symptom, back in 2004. She’s had it twice in her right eye and once in her left, and has been treated with steroids each time.

Her eyesight returned and is still 20/20, but her ability to see color is a little off in her right eye. “I notice it mostly when the doctor does the test where you look at a book to see subtle differences in shade,” she says.

Ellis hasn't seen a pattern to her bouts of optic neuritis. “I have no idea when it might happen,” she says. But she suspects that it, like her other symptoms, may be related to stress.

“I do work a lot, and sometimes I get symptoms because I just traveled or pulled an all-nighter and my body is reacting,” she says.

Other Causes of Optic Neuritis

MS isn't the only possible cause of optic neuritis.

Other medical conditions that have been linked to optic neuritis include other autoimmune disorders, such as lupus, Behçet’s disease, and sarcoidosis, as well as respiratory, fungal, bacterial, and viral infections, according to the National Institutes of Health.

Optic neuritis is a prominent symptom of neuromyelitis optica spectrum disorder (NMOSD), an inflammatory disorder of the central nervous system. NMOSD leads to loss of myelin, the fatty substance that surrounds nerve fibers, in the optic nerve and spinal cord. In the past, NMOSD was thought to be a variant of MS, but it is now believed to be a separate disease.

A vitamin B12 deficiency can also affect your vision, Racke says. It’s important to determine if any underlying condition is causing your optic neuritis so that you're treated appropriately, he says.

Story Source: The above story is based on materials provided by EVERYDAYHEALTH
Note: Materials may be edited for content and length


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