Optic Neuritis: Or something else? Differential Diagnosis

Eyes and ocular appendages (H00-H59).

  • Anterior sham optic neuropathy-acute occlusion of an ophthalmic artery supplying the optic nerve in the Zinn-Haller vascular cortex; also called ocular infarction; clinical presentation: acute onset; no eye movement pain, but diffuse eye pain possible; usually little improvement; ophthalmologic findings: papilledema (congestive papillae): always in the acute stage.
  • Leber’s hereditary optic neuropathy (LHON) – mitochondrial neurodegenerative optic nerve disease; clinical picture: acute optic neuritis without eye movement pain; within a few weeks, the second eye also becomes diseased; occurrence: preferably young men.
  • 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.
  • 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 response?

Neoplasms – tumor diseases (C00-D48).

  • Brain tumors, unspecified
  • Tumor of the anterior visual pathway – acute onset is almost never described; no eye movement pain; spontaneous improvement is very rare; ophthalmologic findings: papilledema (congestion papillae) (possible).