What's happening and why
The optic nerve fibers are covered with a myelin sheath, which speeds up signal transmission. With neuritis, immune cells attack this membrane, conduction is disrupted, and the image reaches the brain distorted and weakened. If the inflammation is located behind the eyeball, the fundus of the eye looks normal in the first days, and the doctor speaks of retrobulbar neuritis. The cause of the autoimmune attack is not fully known, but in some patients it is associated with multiple sclerosis or certain diseases in which specific antibodies are produced.
- Demyelinating neuritis, including in multiple sclerosis
- Neuromyelitis optica spectrum diseases
- Neuritis associated with antibodies to myelin protein
- Infectious neuritis in viral and bacterial infections
- Inflammation in systemic autoimmune diseases
- Nerve damage due to sinusitis and orbital inflammation
Symptoms
Vision usually deteriorates gradually over several hours or days and reaches its worst level around the end of the second week. The person describes a fog, a dark or gray spot in the center, a decrease in the brightness and saturation of colors, especially red. Pain in the depths of the orbit, intensifying when looking to the sides, is typical. Some people experience flashes of light when they move their eyes, as well as blurred vision in the heat, in a hot shower, or after exercise. The second eye with classic neuritis sees normally.
- Loss of vision in one eye over hours or days
- Pain when moving the eye
- Spot in the center of the field of view
- Fading and fading of colors
- Flashes of light when you move your eyes
- Deterioration of vision due to overheating
- Pupillary reaction to light is weakened in the affected eye
Diagnostics
The ophthalmologist evaluates visual acuity, color vision, pupil reaction and examines the fundus; in the retrobulbar form it may be unchanged, and this does not negate the diagnosis. Computer perimetry reveals characteristic loss of the visual field. MRI of the brain and orbits with contrast plays a key role: it confirms nerve inflammation and, equally important, identifies lesions in the white matter of the brain that determine the risk of multiple sclerosis. In case of an atypical picture, the doctor prescribes tests for specific antibodies and examination for infections.
- Testing acuity and color vision
- Assessing pupillary response
- Fundus examination
- Computer perimetry
- MRI of the brain and orbits with contrast
- Optical coherence tomography of the retina
- Tests for specific antibodies in atypical cases
Treatment
In many cases, vision is restored without treatment, but if there is a significant decrease, the doctor prescribes a short course of glucocorticoids in high doses intravenously: it speeds up recovery, although the final level of vision changes only slightly. Taking hormone tablets in low doses is not recommended for this condition. In severe forms and lack of response, plasmapheresis is used. If neuritis turns out to be a manifestation of multiple sclerosis or a related disease, the neurologist selects long-term therapy that changes the course of the disease. Any treatment is prescribed by the doctor after examination.
- Short-course intravenous glucocorticoids according to indications
- Tablet hormones in low doses are not used
- Plasmapheresis for severe cases
- Treatment of the underlying disease by a neurologist
- Observation by an ophthalmologist over time
- Treatment of infection of an infectious nature
Forecast and what's next
Improvement usually begins within two to four weeks, and for most, visual acuity returns to or near its previous level within a few months. Some people still experience a slight decrease in contrast, a feeling of faded colors, or blurred vision when overheated - this is not a sign of a new exacerbation. The main task after recovery is observation by a neurologist, since the risk of developing multiple sclerosis depends on the presence of lesions on MRI. If the disease is identified, early initiation of therapy reduces the frequency of exacerbations.
- Recovery usually takes 1–3 months
- Possible residual reduction in contrast and color perception
- Observation by a neurologist with control MRI
- Early treatment of multiple sclerosis once the diagnosis is confirmed
- A repeated episode is a reason for urgent examination
- Avoid overheating if vision deteriorates in the heat
