Optic neuritis

The optic neuritis (Latin for " optic neuritis "), even retrobulbar neuritis, is an inflammatory disease of the optic nerve, ie, the second cranial nerve. It is to be distinguished from non-inflammatory optic atrophy.

The optic nerve begins in the retina of the eye and enters the optic tract. It conveys the visual information of the retina in the visual centers of the brain (primary visual cortex). Compared to peripheral nerves - cranial nerves also - he is distinguished in that its myelin is not formed by Schwann cells, but by oligodendroglia. That is, its axons behave like axons of the central nervous system. It can therefore at any miterkranken inflammation of the central nervous system. Thus, the optic neuritis is often an early symptom of multiple sclerosis.

Symptoms

The cardinal symptom is the decline of visual acuity ( vision loss ) and a central scotoma can occur. In extreme cases it can come up to complete blindness of the eye. Headache in the area of the eye socket, the increase in the eyeballs when looking twist and pressure, are typical. Depending on the cause can be affected only one eye or both.

Causes and pathophysiology

The spectrum of causative etiologies is very large. Frequently demyelinating diseases such as multiple sclerosis are the cause of optic neuritis. Secondly, chronic intoxications follow ( poisoning ) as with alcohol or quinine. Generalized infectious diseases such as diphtheria, typhoid, typhus, influenza, but also many others as well as pathogen- related diseases of the central nervous system (eg, meningitis, brain abscess ) are also possible. Some metabolic and internal diseases (extreme hypertension ) could have triggered the question. If there is inflammation of the Orbitagewebes or the eye ( eg uveitis, retinitis ) of the optic nerve may be affected. Finally, there are rare inherited disorders, whose image the optic nerve inflammation heard. The optic neuritis is a compulsory part of neuromyelitis optica.

Methods of investigation

Ophthalmologic monitoring is often without pathological findings, the fundus appears in ophthalmoscopy unremarkable ( " the ( eye) doctor sees nothing and the patient sees nothing "). Only if the inflammatory foci are close to the eye, there is an optic disc swelling, but can ( intracranial pressure ) occur in very different diseases. In the late phase after healing of acute inflammation may be a striking pallor usually in the temporal ( temple side ) remain part of the papilla. The diagnosis of a demyelinating disease of the optic nerve can best be using a contrast-enhanced magnetic resonance imaging ( MRI) and make it show up mostly of nerve conduction delays in the investigation of the neurophysiological method of evoked potentials.

Course and prognosis

The choice of therapy and in particular to determine the cause of the prognosis. Often there is already spontaneously in the course of several weeks to several months to improve, partly also to the complete recovery of vision.

Therapy

Basically, the recognized underlying disease must be treated. About two thirds of optic neuritis in Germany are caused by multiple sclerosis. In these cases the appropriate therapy to break the inflammatory thrust is indicated. Infectious diseases are treated with antibiotics liquorgängigen. Often, an anti-inflammatory therapy with corticosteroids is attempted.