Optic nerve
Fiona Rowe in Visual Fields via the Visual Pathway, 2016
Optic or retrobulbar neuritis is an inflammatory or demyelinating disorder of the optic nerve (Figure 6.11). It may be idiopathic or due to a variety of causes such as demyelination which is a common manifestation of multiple sclerosis. Optic neuritis is the presenting sign in 25% of patients with multiple sclerosis and occurs during the course of established disease in about 70%. It is more common in females particularly aged 30–40 years (Beck et al. 2003). Optic neuritis may also occur following post-viral illness, granulomatous inflammation or as an associated infection of the meninges, sinuses or orbit. The typical episode involves one eye only although in children especially it is not unusual for bilateral neuritis to follow viral illness. Optic neuritis improves in the majority of cases to normal or near normal visual function (Beck 1995). Optic neuritis may be preceded or followed by myelopathy which is transverse or ascending with associated paraplegia. This is the condition of neuromyelitis optica (NMO: Devic’s disease). In these cases, the loss of vision is more severe and bilateral (Cabre et al. 2001; Rubiera et al. 2006).
Understanding multiple sclerosis
Ian Robinson in Multiple Sclerosis, 2005
The involvement of optical symptoms in many cases of multiple sclerosis has led to particular concern with the detection and measurement of the pathology of the optic nerve. Optic neuritis and its consequences, traditionally associated with multiple sclerosis and a number of other conditions, have, until fairly recently, been detected through general clinical examination of the eye. However the difficulty of consistently identifying all cases where optical involvement was suspected has led to the development of new procedures. Perhaps the most widely used techniques in connection with the diagnosis of multiple sclerosis are currently tests of visually evoked potentials (VEP). These tests measure the electrical conductivity of the visual system of the brain, and have been found to produce values for most cases with multiple sclerosis which differ significantly from those of the normal population. The reliability of VEPs as a convincing indicator of multiple sclerosis has been questioned by some, who have argued that a variety of conditions and circumstances may produce values which mimic those found with the disease (Poser 1984:243). However, for many clinicians VEPs remain the most useful of the generally available diagnostic aids.
Neurological manifestations of West Nile virus
Avindra Nath, Joseph R. Berger in Clinical Neurovirology, 2020
Aside from optic neuritis, other neuro-ophthalmological manifestations of WNV infection include chorioretinitis, uveitis, and vitreitis [25,38,39]. In one series of 29 patients with serologically proven WNV disease and neurological manifestations, ophthalmological abnormalities were found in 69% of individuals. Chorioretinitis is frequently multifocal and lesions are scattered throughout the posterior and peripheral fundus [40]. In one study of 7 patients (14 eyes) with WNV ocular involvement, the most common findings included multifocal choroidal target lesions in 86%, retinal hemorrhages in 50%, and vitritis in 43%. Ocular findings can be asymptomatic and are often self-limited [38]. Other complications, including optic neuritis and occlusive vasculitis, are more likely to lead to permanent visual loss, but are also much less frequent [40].
Disorders of vision in multiple sclerosis
Published in Clinical and Experimental Optometry, 2022
Roshan Dhanapalaratnam, Maria Markoulli, Arun V Krishnan
Optic neuritis is one of the most common forms of presentation in multiple sclerosis, with 25% of new MS cases presenting with optic neuritis as the initial clinical event. Studies suggest vision is impaired in clinically isolated syndrome in approximately 21-30% of cases, with long tract and brainstem signs making up the majority of other presentations.28–32 Moreover, 50-70% of all patients with multiple sclerosis will experience optic neuritis at some stage of the condition.33 Optic neuritis presents with acute unilateral vision loss. Retro-orbital pain and pain on eye movement are characteristic, occurring in 92% of cases.34 Simultaneous bilateral visual loss or painless visual loss is less commonly seen in multiple sclerosis and may be due to other neurological and systemic conditions (Table 2).
Spaceflight-Associated Neuro-ocular Syndrome (SANS): a review of proposed mechanisms and analogs
Published in Expert Review of Ophthalmology, 2020
Peter Wojcik, Shehzad Batliwala, Tyler Rowsey, Laura A. Galdamez, Andrew G. Lee
One recent study involved identical twin astronauts, with one serving a 1-year mission onboard the ISS and his twin serving as a genetically matched terrestrial control [2]. Differential gene expression analysis indicated many immune-related pathways significantly changed in-flight across the adaptive immune system and innate immune system in the space-observed twin [2]. Other recent space flight studies report suppressed T-cell activation and function in rodents and decreased immune system response in astronauts upon initial return to Earth [45,46]. Recent studies have supported the role of immune dysfunction and autoimmune mechanisms in the development of optic neuritis and other related disorders. There is a paucity of studies in the literature exploring the role of immune system dysfunction in the development of SANS. Such studies would significantly help elucidate what role the immune system may play in the development of SANS.
An Atypical Case of Enterovirus Meningitis Presenting with Unilateral Optic Disc Swelling and Minimal Optical Symptoms
Published in Ocular Immunology and Inflammation, 2023
Efthymios Karmiris, Georgios Vasilakos, Konstantinos Tsiripidis, Evangelia Chalkiadaki
Οur patient had no clinical symptoms and signs except from a reduction in visual quality, therefore, we had to exclude a broad range of diseases causing optic disc swelling, both typical and atypical. There are various possible causes of spontaneous optic neuritis. First, optic neuritis is often a symptom of demyelinating diseases such as multiple sclerosis or neuromyelitis optica spectrum disorders.4 In our case no spinal cord and brain abnormalities were found on brain and spine MRI. In addition, tests for anti-MOG and AQP-4-IgG antibodies showed negative results. Second, the possibility of other autoimmune or systemic diseases were considered. This required comprehensive patient evaluation, including hematologic, spinal and neuroimaging studies, which were all unremarkable in our case. Third we considered optic neuritis due to infectious disease or inflammatory reaction. Optic disc swelling on fundoscopy can be caused by almost all infections.3 When considering the CSF findings of our patient, it was most likely that the diagnosis was enterovirus optic papillitis accompanying aseptic meningitis, even if, surprisingly, the patient had no neurological symptoms.
Related Knowledge Centers
- Optic Nerve
- Demyelinating Disease
- Optic Papillitis
- Optic Disc
- Retina
- Axon
- Multiple Sclerosis
- Visual Impairment
- Leber'S Hereditary Optic Neuropathy
- Viral Disease