Optic neuritis - External and Internal Eye
In the United States, the prevalence of optic neuritis in a predominately white population is 115 per 100,000. Most cases occur in white women between the ages of 15 and 45.
Patients with idiopathic acute optic neuritis typically present with pain and unilateral visual loss over days without systemic or neurological symptoms. Pain is present in more than 90% of cases and often worsens with eye movements. The extent of vision loss can vary and is associated with a loss of color perception. One-third of cases of optic neuritis involve swelling of the optic disc, while most cases have a normal funduscopic examination with retrobulbar optic nerve involvement. As optic neuritis is usually unilateral, an afferent pupillary defect is usually present.
Pediatric Patient Considerations:
While children may experience bilateral optic neuritis more commonly, involvement of both eyes should prompt a search for other causes.
H46.9 – Unspecified optic neuritis
66760008 – Optic neuritis
Differential Diagnosis & Pitfalls
- Hypertensive optic neuropathy – Usually bilateral optic disc swelling and hemorrhages.
- Leber's stellate neuroretinitis
- Anterior ischemic optic neuropathy – Usually painless loss of vision.
- Lyme disease (see Lyme keratitis)
- Papilledema – Usually bilateral and not associated with pain or color vision defects.
- Leber optic neuropathy – Usually affects young males.
- Orbital or optic nerve tumor (see, eg, optic nerve sheath meningioma)
- Toxic optic neuropathy – Also known as tobacco-alcohol amblyopia but may also be seen secondary to other toxins including isoniazid (INH), ethambutol, chloroquine, and chlorpropamide.
- Intracranial mass
Drug Reaction Data