Optic neuritis

Overview

Optic neuritis is an inflammation of the optic nerve that connects the eye with the brain. The optic nerve fibers are coated with myelin — the fatty tissue that protects nerve cells in the same way that insulation protects electrical wiring in a house. Myelin also helps optic nerve fibers conduct electrical impulses to and from the brain.

In most cases, inflammation of the optic nerve is caused by damage to the myelin, called demyelination. Sometimes optic neuritis is sign of neurological conditions such as multiple sclerosis (MS) or Devic's disease.

At UCSF's Children's Hospital, our Regional Pediatric Multiple Sclerosis Center specializes in treating optic neuritis and related degenerative diseases, such as Devic's disease, multiple sclerosis (MS) and acute disseminated encephalomyelitis (ADEM). It is the only center of its kind supported by the National Multiple Sclerosis Society on the West Coast.

Signs & symptoms

Symptoms of optic neuritis vary, but the most common symptom is sudden loss or decrease in vision, including blurred, dark or dim vision and vision in which the contrast or colors seem diluted or "faded."

Another common symptom is pain or discomfort in or around the eye that worsens with movement.

The condition can affect one or both eyes.

In 20 to 25 percent of patients with MS, optic neuritis is the first symptom. The risk of developing MS increases steadily during the first 10 years after an initial onset of optic neuritis but not everyone with optic neuritis has or will develop MS.

Diagnosis

To make a diagnosis, your child's doctor will conduct a thorough eye and physical exam, asking about symptoms your child is experiencing, including when they started and how they've eased or progressed over time. Your child's doctor will record a full medical history, including information about your immediate and extended family's health.

Your child may have an eye exam by an ophthalmologist who will look for optic nerve damage. An evoked potentials test, which records electrical activity in the brain when nerves are stimulated, may also be conducted.

Next, your child may have a magnetic resonance imaging (MRI) scan of the brain. An MRI is a non-invasive procedure that uses powerful magnets and radio waves to construct clear, detailed pictures of brain tissues. It can detect lesions or inflammation in the brain that may indicate your child has multiple sclerosis (MS), or is at a high risk of a recurrent episode of optic neuritis and at risk for developing MS.

Even if your child has a normal MRI scan, this does not necessarily mean that he or she will not experience another episode of optic neuritis in the future.

In some cases, your child may have a lumbar puncture or spinal tap to help in the diagnosis of potential MS. Cerebrospinal fluid (CSF) is the fluid that bathes, cushions and protects the brain and spinal cord. It flows through the skull and spine in the subarachnoid space, the area inside the arachnoid membrane. Abnormalities, such as increased levels of pressure, protein or glucose can be indications of disease.

Additional visual tests may be conducted.

Treatment

Experts at our Regional Pediatric Multiple Sclerosis Center work with each child to develop a customized treatment plan, including long-term follow-up care tailored to your child's needs.

When necessary, we collaborate with other specialists at UCSF or elsewhere to ensure that your child receives the most comprehensive care possible. Because we are part of an international network of six pediatric MS centers sponsored by the National Multiple Sclerosis Society, we have access to the latest information, research and treatments.

In the majority of children, vision problems and eye pain will improve dramatically or disappear completely within a few days or weeks. Sometimes it takes up to six months for full recovery, while some children experience long-term vision problems.

Treatment varies depending on the severity of the condition and whether your child is at a high risk for recurrent episodes and developing multiple sclerosis (MS).

Some children are treated with intravenous (IV) and oral steroids, which can accelerate recovery. Research has shown that high doses of IV steroids in patients who are at a high risk of developing MS may delay the onset of MS.

At this time, there is no single treatment that will absolutely prevent the development of MS in high-risk children with optic neuritis.