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SECTION 5 – Neuro-Ophthalmology

Chapter 37 – Optic neuritis

John R Guy,
Xiaoping Qi

Clinical background

Optic neuritis is an inflammatory disorder of autoimmune optic nerve demyelination. It is often the first clinical sign of multiple sclerosis (MS).[1,2] Optic neuritis is second only to glaucoma as the most common optic neuropathy in the USA. There are approximately 25 000 cases diagnosed per year. Optic neuritis patients are young, typically more than 10 years of age but less than 50 years of age. The clinical symptomatology is characterized by sudden painful visual loss in one eye, although occasionally both eyes can be simultaneously involved. The pain is usually exacerbated by eye movement. Optic neuritis associated with transverse myelitis may be due to Devics disease.

Clinical examination of patients with acute optic neuritis usually reveals a relative afferent pupillary defect (unilateral cases or bilateral cases with asymmetric involvement), visual field deficits, loss of visual acuity, …