Optic Neuritis

Jeffrey L. Bennett, MD, PhD, FAAN Neuro-ophthalmology p. 1236-1264 October 2019, Vol.25, No.5 doi: 10.1212/CON.0000000000000768
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PURPOSE OF REVIEW This article discusses the clinical presentation, evaluation, and management of the patient with optic neuritis. Initial emphasis is placed on clinical history, examination, diagnostic testing, and medical decision making, while subsequent focus is placed on examining specific inflammatory optic neuropathies. Clinical clues, examination findings, neuroimaging, and laboratory testing that differentiate autoimmune, granulomatous, demyelinating, infectious, and paraneoplastic causes of optic neuritis are assessed, and current treatments are evaluated.

RECENT FINDINGS Advances in technology and immunology have enhanced our understanding of the pathologies driving inflammatory optic nerve injury. Clinicians are now able to interrogate optic nerve structure and function during inflammatory injury, rapidly identify disease-relevant autoimmune targets, and deliver timely therapeutics to improve visual outcomes.

SUMMARY Optic neuritis is a common clinical manifestation of central nervous system inflammation. Depending on the etiology, visual prognosis and the risk for recurrent injury may vary. Rapid and accurate diagnosis of optic neuritis may be critical for limiting vision loss, future neurologic disability, and organ damage. This article will aid neurologists in formulating a systematic approach to patients with optic neuritis.

Address correspondence to Dr Jeffrey L. Bennett, Department of Neurology, 12700 E 19th Ave, Box B-182, Aurora, CO 80045, [email protected].

RELATIONSHIP DISCLOSURE: Dr Bennett serves on the editorial boards of the Journal of Neuro-ophthalmology, Multiple Sclerosis, and Neurology: Neuroimmunology & Neuroinflammation and as a consultant for AbbVie Inc; Alexion; Chugai Pharmaceutical Co, Ltd; Clene Nanomedicine; EMD Serono, Inc; Equillium, Inc; Frequency Therapeutics; Genentech, Inc; MedImmune; and Sanofi Genzyme. Dr Bennett has received research/grant support from EMD Serono, Inc; the Guthy-Jackson Charitable Foundation; Mallinckrodt Pharmaceuticals; the National Eye Institute (R01EY022936); the National Institute of Allergy and Infectious Diseases (UM1AI110498); and Novartis AG. Dr Bennett receives publishing royalties from UpToDate, Inc, and has received personal compensation for serving as a medicolegal consultant on medical cases involving neuroinflammatory and neuro-ophthalmologic disorders.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Bennett discusses the unlabeled/investigational use of plasma exchange and apheresis for the treatment of optic neuritis.

© 2019 American Academy of Neurology.