Overview

Optic neuritis occurs when swelling (inflammation) damages the optic nerve — a bundle of nerve fibers that transmits visual information from your eye to your brain. Common symptoms of optic neuritis include pain with eye movement and temporary vision loss in one eye.

Signs and symptoms of optic neuritis can be the first indication of multiple sclerosis (MS), or they can occur later in the course of MS. MS is a disease that causes inflammation and damage to nerves in your brain as well as the optic nerve.

Besides MS, optic nerve inflammation can occur with other conditions, including infections or immune diseases, such as lupus. Rarely, another disease called neuromyelitis optica causes inflammation of the optic nerve and spinal cord.

Most people who have a single episode of optic neuritis eventually recover their vision without treatment. Sometimes steroid medications may speed the recovery of vision after optic neuritis.

Symptoms

Optic neuritis usually affects one eye. Symptoms might include:

  • Pain. Most people who develop optic neuritis have eye pain that's worsened by eye movement. Sometimes the pain feels like a dull ache behind the eye.
  • Vision loss in one eye. Most people have at least some temporary reduction in vision, but the extent of loss varies. Noticeable vision loss usually develops over hours or days and improves over several weeks to months. Vision loss is permanent in some people.
  • Visual field loss. Side vision loss can occur in any pattern, such as central vision loss or peripheral vision loss.
  • Loss of color vision. Optic neuritis often affects color perception. You might notice that colors appear less vivid than normal.
  • Flashing lights. Some people with optic neuritis report seeing flashing or flickering lights with eye movements.

When to see a doctor

Eye conditions can be serious. Some can lead to permanent vision loss, and some are associated with other serious medical problems. Contact your doctor if:

  • You develop new symptoms, such as eye pain or a change in your vision.
  • Your symptoms worsen or don't improve with treatment.
  • You have unusual symptoms, including vision loss in both eyes, double vision, and numbness or weakness in one or more limbs, which can indicate a neurological disorder.

Causes

The exact cause of optic neuritis is unknown. It's believed to develop when the immune system mistakenly targets the substance covering your optic nerve, resulting in inflammation and damage to the myelin.

Normally, the myelin helps electrical impulses travel quickly from the eye to the brain, where they're converted into visual information. Optic neuritis disrupts this process, affecting vision.

The following autoimmune conditions often are associated with optic neuritis:

  • Multiple sclerosis. Multiple sclerosis is a disease in which your autoimmune system attacks the myelin sheath covering nerve fibers in your brain. In people with optic neuritis, the risk of developing multiple sclerosis after one episode of optic neuritis is about 50% over a lifetime.

    Your risk of developing multiple sclerosis after optic neuritis increases further if an MRI scan shows lesions on your brain.

  • Neuromyelitis optica. In this condition, inflammation affects the optic nerve and spinal cord. Neuromyelitis optica has similarities to multiple sclerosis, but neuromyelitis optica doesn't cause damage to the nerves in the brain as often as multiple sclerosis does. Still, neuromyelitis optica is more severe than MS, often resulting in a diminished recovery after an attack compared with MS.
  • Myelin oligodendrocyte glycoprotein (MOG) antibody disorder. This condition can cause inflammation to the optic nerve, spinal cord or brain. Similar to MS and neuromyelitis optica, recurrent attacks of inflammation can occur. Recovery from MOG attacks is usually better than recovery from neuromyelitis optica.

When symptoms of optic neuritis are more complex, other associated causes need to be considered, including:

  • Infections. Bacterial infections, including Lyme disease, cat-scratch fever and syphilis, or viruses, such as measles, mumps and herpes, can cause optic neuritis.
  • Other diseases. Diseases such as sarcoidosis, Behcet's disease and lupus can cause recurrent optic neuritis.
  • Drugs and toxins. Some drugs and toxins have been associated with the development of optic neuritis. Ethambutol, used to treat tuberculosis, and methanol, a common ingredient in antifreeze, paints and solvents, are associated with optic neuritis.

Risk factors

Risk factors for developing optic neuritis include:

  • Age. Optic neuritis most often affects adults ages 20 to 40.
  • Sex. Women are much more likely to develop optic neuritis than men are.
  • Race. Optic neuritis occurs more often in white people.
  • Genetic mutations. Certain genetic mutations might increase your risk of developing optic neuritis or multiple sclerosis.

Complications

Complications arising from optic neuritis may include:

  • Optic nerve damage. Most people have some permanent optic nerve damage after an episode of optic neuritis, but the damage might not cause permanent symptoms.
  • Decreased visual acuity. Most people regain normal or near-normal vision within several months, but a partial loss of color discrimination might persist. For some people, vision loss persists.
  • Side effects of treatment. Steroid medications used to treat optic neuritis subdue your immune system, which causes your body to become more susceptible to infections. Other side effects include mood changes and weight gain.

Feb. 12, 2020
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