Neuritis Nervi Optici: Causes, Symptoms & Treatment

Neuritis nervi optici is an inflammation of the optic nerve. It is often an early symptom of multiple sclerosis.

What is neuritis nervi optici?

In medicine, neuritis nervi optici is also known as optic neuritis or optic neuritis. If the inflammation appears within the optic nerve head, it is referred to as papillitis; if, on the other hand, it occurs in the posterior segment of the optic nerve, it is referred to as retrobulbar neuritis. Neuritis nervi optici is accompanied by swelling of the nerve fibers located at the optic nerve head and by circulatory disturbances. As a result, there is a risk of optic nerve damage and loss of vision. In the worst case, blindness may result. In most cases, neuritis nervi optici presents on one side. The disease is also considered an early sign of multiple sclerosis. People between the ages of 20 and 45 are particularly affected by optic neuritis. The disease is more common in women than in men.

Causes

The causes of optic neuritis vary. It not infrequently manifests as part of multiple sclerosis, which is an autoimmune disease. The myelin sheaths of the nerves are attacked. Impairment of the myelin sheaths disrupts the transmission of nerve signals. However, other autoimmune diseases such as lupus erythematosus and sarcoidosis are also possible causes of optic neuritis. Children can also suffer from optic neuritis. In most cases, they suffer from papillitis caused by general infections such as the common cold. However, in about 70 percent of all children with optic neuritis, no specific cause for the inflammation can be found. Sometimes optic neuritis develops as a result of diseases such as malaria, Lyme disease or syphilis. Occasionally, sinusitis (inflammation of the sinuses) is also the trigger of neuritis nervi optici.

Symptoms, complaints, and signs

The main symptom of neuritis nervi optici represents the deterioration of vision. Already within days or even hours, there may be a significant reduction in vision. The loss of vision is primarily noticeable in the central part of the visual field. The affected person sees as if through a gray veil or a frosted glass. In addition, pain occurs in the eye, which is triggered by eye movements. The pain is often perceived very differently. They can be sharp, throbbing, dull or diffuse. In addition, the eyes react extremely sensitively. Not infrequently, the patient also suffers from color saturation disorders or color blindness, which is particularly the case with the color red. Likewise, the pain can be intensified by warmth, which physicians refer to as the Uthoff phenomenon. If the patient takes a warm bath, for example, this often leads to a deterioration of vision. In about 30 percent of all patients, light flashes also occur. Pressure and bright light also promote pain.

Diagnosis and course of the disease

If the complaints of neuritis nervi optici lead the patient to the doctor, he first asks some questions. For example, he wants to know whether there is pain when the eyes move, whether one eye sees worse than the other, since when the vision has deteriorated, whether there have been recent flu-like infections or febrile illnesses, and whether there is a cardiovascular disease. Also of importance are possible cases of multiple sclerosis within the family, whether the patient perceives flashes of light and whether he consumes alcohol or tobacco and regularly takes medication. The interview is followed by determination of visual acuity, with the patient reading letters and numbers on a chart. The doctor shines a small lamp into the eyes to test pupil reaction. Furthermore, the mobility of the eyes is checked. The patient follows the doctor’s finger or a pencil and indicates whether he or she feels pain or sees double images. Furthermore, an examination of the back of the eye is performed. For this purpose, the doctor shines an ophthalmoscope (eye mirror) into the eyes to assess the retina. Other diagnostic methods include a check of color perception and a test of optic nerve conduction. If multiple sclerosis is suspected, a magnetic resonance imaging (MRI) or a lumbar puncture may be performed.If multiple sclerosis is responsible for the optic neuritis, vision can be improved by medical treatment. Otherwise, the course of neuritis nervi optici varies. Sometimes the inflammation lasts for two weeks and then improves spontaneously. In severe cases, however, the symptoms may persist permanently.

Complications

Optic neuritis, called neuritis nervi optici, can have several causes and is often an indicator of the onset of multiple sclerosis (MS). The type of complications that occur depend on the causative factors of the neuritis and the location of the inflammatory focus. It can be located directly in the area where the nerve fibers exit the eyeball (papillitis) or in the posterior part of the optic nerve in the form of retrobulbar neuritis. Typical complications include vision deterioration, veil vision, and pain in the eye during eye movements. In addition, the eyes are sensitive to light stimuli and flashes of light are seen in about one-third of all cases. If the affected person does not have high blood pressure, diabetes or tuberculosis, the neuritis often heals without treatment and the symptoms may disappear completely. In other cases, a cause-fighting treatment is required to eliminate the symptoms and complications. If the optic nerve inflammation is triggered by an autoimmune reaction, therapy that suppresses the immune system, such as immunosuppressants, is helpful. In these cases, the symptoms would worsen if left untreated, which in extreme cases would lead to complete blindness in the affected eye. Heavy smoking and excessive alcohol consumption have an unfavorable effect on the course of the disease.

When should one go to the doctor?

In the event of a decrease in vision, a visit to the doctor is always necessary. If the affected person notices the first losses of vision in everyday life, he should act immediately. It must be clarified whether this is a natural aging process or a serious disease. To reduce the risk of accidents or falls, a doctor should be consulted. A change in color perception, blurred vision or the inability to perceive people or objects in detail must be examined. If the affected person notices that his or her vision has deteriorated in direct comparison to people in his or her social environment, he or she needs help. If there is a headache or a feeling of pressure around the eyes, there is cause for concern. If the complaints persist over several days, increase in intensity or occur repeatedly, a doctor should be consulted. Some sufferers also complain of pain in the eye region. This may move into the head or radiate into the visual field. Both indications should be presented to a physician. If the pain develops on exposure to light, this is worrisome and action is needed. If changes or abnormalities occur in the field of vision, these should be clarified medically. When seeing flashes of light, a flicker or the perception of unusual shadowy contours, a visit to the doctor is advisable.

Treatment and therapy

The therapy of neuritis nervi optici depends on its causes. If the inflammation is caused by multiple sclerosis, the patient receives immunosuppressants. They cause suppression of the immune system. These are usually glucocorticoids such as methylprednisolone or cortisone. Their dosage is high at the beginning of therapy and is lowered in the further course. However, the patient must not suffer from high blood pressure, diabetes, gastric ulcers or tuberculosis, as this would lead to a worsening of the diseases. Later, a special treatment for multiple sclerosis is given. If bacteria are the triggers of optic neuralgia, the patient can be given antibiotics. In principle, the patient must take it easy and stay in bed. Since optic neuralgia often resolves spontaneously without therapy, special treatment is not always necessary.

Outlook and prognosis

With prompt and early diagnosis, the subsequent course of the disease is favorable in most patients. The inflammation present is treated by the administration of medication, so that complete freedom from symptoms is possible within a few days or weeks. The prerequisite for a good prognosis is a fundamentally intact immune system and a patient who has no other diseases.Nevertheless, the affected person should seek medical assistance even if he or she is in good general condition, otherwise there may be a rapid increase in existing symptoms and further loss of vision. The disease is characterized by rapid progression and in many cases indicates the presence of another underlying disease. For this reason, seeking medical attention is advised. If other diseases are present, the otherwise favorable prognosis often worsens. In particular, patients with a chronic underlying condition or persistent blood pressure symptoms are likely to experience complications as well as further health challenges. Chronic discomfort may occur and quality of life is reduced. Many patients must remain on bed rest to experience long-term symptom relief. If the disease progresses unfavorably, multiple sclerosis is diagnosed later in the course of the disease. The loss of vision is often an indication of the disease at hand.

Prevention

Preventive measures against neuritis nervi optici are not known. However, abstaining from tobacco and alcohol is considered useful.

Aftercare

In most cases of neuritis nervi optici, only very few and also only very limited measures or possibilities of direct aftercare are available. For this reason, affected individuals should see a physician at a very early stage to prevent the occurrence of other symptoms and complications. There may also be no complete cure, so affected individuals should contact a physician. As a rule, neuritis nervi optici is treated by taking various medications. Patients should always ensure that they take the medication regularly and in the correct dosage. All the doctor’s instructions should also be followed, and a doctor should always be consulted first if there are any questions or if anything is unclear. If neuritis nervi optici is treated by taking antibiotics, alcohol should not be consumed during the treatment. Often patients are also dependent on the help of their own family in everyday life. This can also prevent the development of depression and other psychological upsets. In most cases, this disease does not reduce the life expectancy of the patient, although the further course depends very much on the time of diagnosis.

What you can do yourself

Provided that it has been ruled out that an autoimmune disease is the trigger of the disease, there are ways to prevent a new disease. Since the triggers of the disease are unfortunately often not sufficiently known, it is of course difficult to target the right steps. However, it is certain that toxic and irritating substances can trigger neuritis nervi optici, which is why contact with them must be avoided as far as possible. However, these include not only aggressive cleaning agents or sprays, but also alcohol, nicotine and bitter drinks spiked with quinine. A healthy diet with few additives can ensure a low-irritant environment and minimize the risk of new illnesses. If unsure, a nutritionist will be happy to help and develop an individualized diet plan. The immune system itself also plays a very important role, and not only in the case of infection-related illness. Low stress, sufficient sleep and a healthy diet already ensure an intact immune system in most cases. The immune system can largely defend itself against pathogens by recognizing them and eliminating them at an early stage. Only when the pathogen density is too high do corresponding symptoms appear. However, if there is even the slightest sign of a new disease, an ophthalmologist must be consulted immediately, who can initiate the appropriate treatment and thus counteract the possible loss of vision at an early stage.