Imagine that you suddenly lose a little vision in one eye, and you also feel pain when you move your eye. Maybe you don't see colors as well as before, they seem a little faded. It's normal to feel a little scared when something like this happens. These are the main symptoms of a condition called Optic Neuritis that we're talking about today. Although this is not very commonly discussed, it's very important for us all to be aware of it because it affects our eyesight.
Simply put, what is Optic Neuritis?
Optic Neuritis (ON) is a neurological condition. It is caused by inflammation of the optic nerve , the nerve that connects our eyes to our brain. Think of the optic nerve as a 'wire' that carries messages from our eyes to our brain. This 'wire' is what sends the information we see to our brain, telling us, "Oh, this is amazing."
These nerve cells have a fatty covering around them. It's like a wire with insulation around it. We call this the myelin sheath. When Optic Neuritis occurs, this protective myelin sheath is damaged. Then the messages that go through that wire don't go through properly. The messages get confused. That's why this disease causes vision loss, pain, and other vision problems .
What are the main types of Optic Neuritis?
This condition can be divided into three main types. Each type is a little different. Let's see what they are.
| Type | Description |
|---|---|
| Typical | This is the most common type. It usually affects only one eye. Even without treatment, most people recover within a few days. However, doctors definitely recommend treatment for this for other reasons. |
| Atypical | This type usually affects both eyes. It also doesn't heal quickly. Research has found that this condition may be associated with other complex neurological diseases. |
| Pediatric (type that occurs in young children) | This is the type of Optic Neuritis that occurs in young children. Although it has similarities to the other two types, there are some important differences. But the good news is that this type is much more likely to be completely cured. |
What are the symptoms of this condition?
The symptoms of Optic Neuritis are almost all related to our eyes and vision. Most of the time, these symptoms are caused by damage to the nerve behind the eyeball (`retrobulbar`). Let's take a look at the main symptoms.
| Symptom | A Simple Explanation |
|---|---|
| Eye pain | This is the main symptom. More than 90% of people experience this pain. The pain increases especially when moving the eyes . However, in some atypical types, the pain may disappear altogether. |
| Decreased visual acuity | This means that you see things blurry and unclear. To be precise, your vision acuity is reduced. This can be particularly severe in young children. |
| Loss of part of the visual range | This is when you lose a gap or part of your visual field. In Optic Neuritis, this gap often occurs in the center of your vision. |
| Color blindness (Dyschromatopsia) | This is also something that happens to many people. Colors don't appear as they should. They seem faded and dull. It can be especially difficult to distinguish the color red . |
What causes Optic Neuritis?
We now know that Optic Neuritis is caused by inflammation of the optic nerve. So there are a number of possible causes for this inflammation .
Autoimmune and inflammatory conditions
This is what researchers suspect is the main cause. An autoimmune disease is when our body's defense system, the immune system , mistakenly attacks our own good cells.
- Typical Optic Neuritis: This type is often associated with a condition called Multiple Sclerosis (MS) . In fact, many people are first diagnosed with MS when they develop Optic Neuritis. It has been found that about 50% of people who develop Optic Neuritis will develop MS within 15 years.
- Atypical Optic Neuritis: This type is associated with other autoimmune diseases such as Neuromyelitis Optica (NMO) and MOG-antibody-associated disease (MOGAD) .
Infections
Various infections can also damage nerves. The same is true for the optic nerve. Infections are especially likely to cause Optic Neuritis in young children.
- Viral infections: Viruses like chickenpox, herpes, cytomegalovirus, HIV, mosquito-borne viruses, and measles.
- Bacterial infections: Cat scratch fever, Lyme disease, tuberculosis, and syphilis.
- Fungal infections: Fungal infections like Cryptococcosis and Candidiasis.
- Parasitic infections: Toxoplasmosis, which is transmitted from cats, and Toxocariasis, which is transmitted from dogs.
Some drugs and toxins
Some medications and other toxins we take can also cause this.
- Medicines given for certain infections (e.g. ethambutol).
- Heart rhythm medications (e.g. amiodarone).
- Medicines for malaria (e.g. chloroquine, hydroxychloroquine).
- Anticancer drugs.
- Tobacco and nicotine products.
- Alcohol and methanol.
Other reasons
- Reduced blood supply (ischemia):If the optic nerve does not receive the necessary amount of blood, the nerve cells can be damaged.
- Vitamin deficiencies: Vitamin B12 deficiency in particular can cause serious, permanent damage to the nerves.
- Nerve compression: Compression of the optic nerve due to a brain tumor or other cause.
- Diabetes (Type 2 diabetes): If diabetes is not controlled, the risk of nerve damage due to high blood sugar levels is high.
Who is at higher risk of developing this condition?
Certain factors may increase the risk of developing Optic Neuritis.
- Gender: The typical type is more likely to develop in women than in men, while the atypical type is more common in men.
- Age: The typical type is most common in people between the ages of 20 and 40. The atypical type is more common in people under the age of 18 or over the age of 50.
- Race: White people are at higher risk of developing this disease.
- Location: People living in colder countries, far from the equator, have a slightly higher risk of developing MS-related optic neuritis. This is thought to be influenced by sun exposure and vitamin D levels.
- Having other autoimmune diseases: People with diseases like lupus and sarcoidosis are at higher risk.
How does the doctor diagnose this disease exactly?
If you have these symptoms, you should first see an eye care specialist. He or she will ask you about your symptoms and your medical history. Then, they will perform a complete eye exam.
Remember, never ignore a change in your vision, especially if it's accompanied by pain. See a doctor as soon as possible.
The testing process may include:
- Checking visual acuity.
- Visual field testing.
- Examining how colors appear.
- Examining pupil reflexes.
After these tests, if the doctor suspects that this is Optic Neuritis, he will refer you for further tests. Among them, an MRI scan is very important.
An MRI scan can clearly show whether there is inflammation of the optic nerve. It can also look for any changes in the brain (`brain lesions`) if there is any doubt that this is caused by MS.
In addition, blood tests and urine tests may be done to check for infection or antibodies to diseases such as NMO or MOGAD. Sometimes a lumbar puncture may also be done.
What are the treatments for this?
There are two main methods of treating optic neuritis.
1. Steroids to reduce inflammation: Steroids are often given intravenously (IV) for 3-5 days in high doses. This can quickly reduce swelling and inflammation in the nerve, reduce pain, and help restore vision. Then, your doctor may give you steroids in the form of pills to take for a short period of time. It is important to take these medications exactly as your doctor tells you to.
2. Treating the underlying cause: If it is caused by an infection, antibiotics will be given. If it is caused by an autoimmune disease like NMO or MOGAD, you may need to undergo specific treatments like plasma exchange (PLEX).
Your doctor will determine the best treatment for your condition.
How long will this condition last? Will my vision return?
This varies depending on the type of disease, the treatment you receive, and how your body responds to it.
- Typical Optic Neuritis: This is often a short-term problem. The pain goes away in a few days. It can take two weeks to three months for vision to fully return to normal. In about 90% of cases, vision returns to normal or near normal within a year.
- Atypical Optic Neuritis: This is a bit more serious. Symptoms may last longer. Vision may not fully recover. Therefore, it is very important to recognize this type early and start treatment.
- Pediatric: Children have a much better chance of recovery than adults. Long-term effects are rare. However, if a child develops this, it can be an early sign of MS, so doctors are wary of it.
What do you do in an emergency?
If you suddenly lose your vision , it is a medical emergency. You should go to the nearest hospital Emergency Department (ETU) immediately. Also, if you have any changes in your vision, pain, or blurring, do not ignore it and see a doctor immediately. The sooner you start treatment, the better your chances of saving your eyes.
Take-Home Message
- Pain when moving the eyes and blurred or decreased vision are the main symptoms of Optic Neuritis.
- Never ignore these symptoms. See an ophthalmologist as soon as possible. If you suddenly lose your vision, go to a hospital's ETU immediately.
- Optic neuritis can be the first symptom of other serious conditions, such as multiple sclerosis (MS), so an accurate diagnosis is very important.
- There are effective treatments for this. The sooner treatment is started, the better the chance of vision recovery.
- Follow your doctor's instructions exactly. Take the medicine in the prescribed dosage and at the prescribed time.
Optic neuritis, eye pain, vision loss, MS, multiple sclerosis, neurological disease
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