Optic Neuritis: Causes

Pathogenesis (development of disease)

Typical optic neuritis occurs either in the setting of multiple sclerosis (majority of cases) or idiopathically (with no apparent cause).

It involves a T-cell-, B-cell-, and microglia-mediated immune reaction against optic nerve tissue.

Atypical optic neuritis may result from the following disease mechanisms:

  • As a manifestation of an autoimmune disease, eg.
    • Chronic relapsing inflammatory optic neuropathy (CRION).
    • Lupus erythematosus
    • Neuromyelitis optica (NMO; synonyms: Devic syndrome; neuromyelitis optica spectrum disorders (NMOSD)) Neuromyelitis optica (NMO; synonyms: Devic syndrome; neuromyelitis optica spectrum disorders (NMOSD) – atypical optic neuritis belonging to the group of rare autoimmune inflammatory diseases of the central nervous system; occurrence in 1-3% of optic neuritis.
    • Sarcoidosis – granulomatous inflammation, which is considered an inflammatory multisystem disease, the cause of which is still unclear.
  • Postinfectious (after infection) or postvacinal (after vaccination).
  • infectious/parainfectious
    • Lyme disease – infectious disease caused by the bacterium Borrelia burgdorferi.
    • Syphilis (lues)/sexual disease
    • Neuroretinitis – spread of inflammation from the optic nerve to the retina; marked papilledema and involvement of the macula (“point of sharpest vision”; yellow spot); etiology: possibly a bacterially triggered immune reaction?; e.g., by Bartonella.

Etiology (causes)

Biographical causes

  • Gender – Women are affected in more than 70% of cases.

Disease-related causes

  • Atypical optic neuritis (see above under pathogenesis).
  • Multiple sclerosis (MS) (= typical optic neuritis).

Medication

  • Interferon alfa-2a, peginterferon alfa-2a