Definition of optic neuritis
The exact name depends on which part of the optic nerve is inflamed. If the inflammation is in the optic nerve head, it is called papilitis. If the inflammation is further back in the optic nerve, it is called retrobulbar neuritis.
The inflammation of the optic nerve causes swelling (edema) of nerve fibers in the optic nerve head. Often, the disease is accompanied by a disturbance of the blood circulation, which in turn leads to damage to the optic nerve and impaired vision. This deterioration in vision can lead to blindness. In most cases the inflammation of the optic nerve is one-sided.
How common is optic neuritis?
Optic nerve inflammation is one of the most common diseases in the retinal area. Mostly adults between 20 and 45 years of age are affected. Men are less likely than women to suffer from optic nerve inflammation.
If the front part of the optic nerve becomes inflamed (papillitis), the person affected feels a dull feeling of pressure in the rear part of the eyeball and a severe visual disturbance. Eye movements are painful because the swollen optic nerve cannot easily follow the eye movements and is thus additionally irritated. Fever is a frequent accompanying symptom and a color perception disorder (color blindness) can occur.
If the anterior part of the optic nerve is affected, the inflammation can be detected by examination with an ophthalmoscope. Behind the eyeball, however, an inflammation is not visible in the ophthalmoscope, and the papilla appears almost unchanged in the case of optic nerve inflammation, since the inflammation is located only behind it. The so-called visual field examination shows an extensive loss in the middle of the visual field.
Inflammation of the optic nerve can occur as a result of multiple sclerosis (see below) or bacterial infection. Other diseases such as lupus erythematosus may also be the cause. In addition to the typical symptoms such as impaired vision and loss of visual field, patients also report unpleasant pain.
The pain occurs in the affected eye. Since the inflammation can also occur simultaneously in both eyes, the pain can therefore also be felt in both eyes. Patients report pain around the eye or deep inside the head.
The pain originating from the inflammation can also spread and also lead to headaches. The character of the pain can be very different. It can be diffuse, dull, throbbing or stabbing and accompanied by headache.
If nerves other than the optic nerve are affected by the inflammation, for example, the nerves responsible for eye movements, pain can also occur when the eyes are moved in different directions. The eyes can also be very sensitive. Bright light can be an additional irritation due to the inflammation and can briefly worsen the pain.
The eye can also be sensitive to pressure. Furthermore, heat in the form of hot baths or hot showers can also increase the discomfort. An inflammation of the optic nerve usually heals well on its own.
The subsidence of the inflammation can be supported and accelerated by anti-inflammatory drugs such as cortisone. To treat the pain, additional pain-relieving medication such as ibuprofen can be taken. In most cases, the pain subsides as the inflammation subsides, and headaches and sensitivity to light also subside.
However, complete healing can take several weeks to months. Inflammation of the optic nerve may then reoccur and be accompanied by similar symptoms. Visual disturbances and pain in the eye should be examined by a doctor to exclude a more serious underlying disease.
If the symptoms do not improve, it is also advisable to consult a doctor for advice and treatment. If foci of infection in the brain are the cause of the optic nerve inflammation, high doses of cortisone are recommended. The causative disease is treated in the case of papillitis.
If the cause of retrobulbar neuritis cannot be determined, a checkup with a neurologist, ENT specialist and internist is necessary before effective treatment. In severe cases of optic neuritis, treatment with high-dose cortisone is urgent to ensure that vision is restored more quickly. However, the following other diseases must be ruled out beforehand: Tuberculosis, stomach ulcer, diabetes mellitus and high blood pressure.Cortisone is a steroid hormone which is synthesized in the adrenal cortex by the body itself.
The synthetically (artificially) produced cortisone acetate is used for the therapy of various inflammatory diseases. In the body, especially in the liver, it is broken down to the actively active cortisol and can develop its effectiveness. Cortisone is thus also used to treat optic nerve inflammation.
As an anti-inflammatory drug, it slows down the inflammatory process and supports the body in the healing process. Cortisone can be administered orally or, in acute cases, also in high doses intravenously and can therefore act more quickly. Treatment with cortisone reduces the inflammation more quickly, but in the case of underlying multiple sclerosis, the disease cannot be stopped.
It helps to stop the inflammation in the short term, but due to the severe side effects, cortisone treatment should be carefully considered. Side effects include weight gain, osteoporosis, water retention and general immune deficiency. Cushing’s syndrome changes the body image.
The patient gains weight, fat is redistributed and in the long run the muscle mass is reduced. These additional symptoms should be taken into account when treating with cortisone. Especially in children, the cause of optic nerve inflammation is usually a general infection.
If the optic nerve head becomes inflamed (papillitis), the cause cannot be determined in 70% of cases. Inflammatory processes are possible in infectious diseases such as Lyme disease, malaria or syphilis. Likewise, autoimmune diseases (facial erysipelas, polychondritis, Crohn’s disease, ulcerative colitis, panarteritis nodosa, Wegener’s disease) can cause inflammation of the optic nerve head.
The most common cause of inflammation of the posterior part of the optic nerve is multiple sclerosis. An incipient multiple sclerosis is announced in 30 to 40% of cases by such an inflammation. Conversely, however, retrobulbar neuritis occurs in only one in five patients with multiple sclerosis.
Another cause of Retrobulbar Neuritis can be inflammation of the paranasal sinuses. In 20 to 40% of cases, neuritis (inflammation of the nerve) turns into encephalitis, since the structures are very close together and the optic nerve is part of the brain in terms of developmental history. Especially in patients with multiple sclerosis, vision usually improves under therapy.
Before the visual acuity recovers, there may be a temporary further decrease during the disease. In rare cases, a loss of the central visual field remains. In 95% of patients suffering from optic nerve inflammation, significant improvement in vision is observed after one year.
However, re-disease is often observed, in 15% of cases it occurs within 2 years. In some cases, optic nerve atrophy occurs after the inflammation has subsided. An optic nerve inflammation can develop very quickly and does not always show the same course and symptoms.
If the inflammation is already well advanced, it can last up to two weeks before a spontaneous improvement is seen. The subsidence of the inflammation can be accelerated by targeted treatment with anti-inflammatory drugs such as Corstion. Nevertheless, it can take several weeks or even months until all symptoms have disappeared.
However, if there is a very severe inflammation or if damage to the optic nerve is manifested as part of an autoimmune disease such as multiple sclerosis, some symptoms may remain permanently. The remaining damage depends on the severity of the inflammation and its spread to the eye. In order to shorten the duration of the inflammation, it is important that the patient does not ignore the first signs and sees a doctor early.
This doctor can initiate the appropriate therapy and thus avoid serious complications. Multiple sclerosis is an autoimmune disease in which the immune system attacks the myelin sheaths of the central nervous system. It is a progressive chronic inflammatory disease.
The body’s own immune cells attack healthy nerve tissue and destroy it. So far, there is no therapy that can stop this destruction. In MS, the optic nerve of the eye is also attacked.
The inflammation of the optic nerve is also called optic neuritis or neuritis nervi optici in medical terminology. It is often a first symptom of multiple sclerosis. The inflammation of the optic nerve initially manifests itself with pain in the eye area.
Many patients report the pain felt behind the eyeball. The nerve is eventually demyelinated and thus damaged to such an extent that eventually visual disturbances also occur.These visual disturbances manifest themselves as an increasing blurred visual field. Individual areas of the visual field can eventually fail completely.
In addition, the perception of contrast and color can also be reduced. In addition to these typical symptoms, headaches can also occur more frequently. Some patients also report that they perceive flashes of light.
These complaints are also part of the symptomatology of optic nerve inflammation and are signs of damage to the optic nerve. Furthermore, double images may also occur, which are an indication that the visual pathway on one side of the brain is already affected by the inflammation. The acute inflammation lasts for about one to two weeks and then stops suddenly.
However, the nerve is often damaged, especially if multiple sclerosis is the cause. The symptoms will therefore not improve and the extent of the remaining damage depends on the severity of the nerve damage. The inflammation of the optic nerve often reoccurs with a new attack of multiple sclerosis.
With each further inflammation or worsening of the disease, the optic nerve is more severely damaged. This can eventually lead to complete blindness. Since an inflammation of the optic nerve usually heals on its own, the therapy for an existing multiple sclerosis is aimed at stopping the relapse and slowing down the progression of the nerve damage.
In this way, the symptoms can also be alleviated. Anti-inflammatory drugs achieve short-term success, but the underlying disease MS cannot be stopped in the long term.