Understanding Optic Neuropathy at Medline Plus
Optic neuropathy is a general term which refers to a disorder or injury of the optic nerve due to any cause. Glaucoma (raised intraocular pressure) is a well-known type of optic neuropathy. Causes of optic neuropathy may include infections, trauma, ischemia (lack of blood supply to the nerve), compressive tumor, autoimmune diseases such as lupus and multiple sclerosis, injury from radiation, and in rare cases, the cause may be genetic. Sudden inflammation of the optic nerve (optic neuritis) leads to swelling and destruction of the nerve’s outer, protective shell (myelin sheath). Read more at Medline Plus.
Anterior Ischemic Optic Neuropathy Information from the Carver College of Medicine, University of Iowa
Information from patients, lay persons, and physicians from the Department of Ophthalmology & Visual Sciences,
Carver College of Medicine, University of Iowa.
Optic Neuritis information at Mayo Clinic
Optic Neuritis information at MayoClinic.com
Optic Nerve Atrophy.
Death of the nerve tissue (atrophy) results from ischemia and most often affects the elderly. The condition may lead to sudden vision impairment in one eye, pupil reactions, loss of color vision and pain on eye movement. Tests to find the exact cause of the neuropathy will help determine treatment. In many cases vision returns to normal in 2 – 3 weeks with no treatment. IV corticosteroids may speed recovery, but complications can arise. Patients with multiple sclerosis or lupus have a poorer prognosis. Read more at Medline Plus.
Optic neuropathy caused by compression of the optic nerve.
Compression of the optic nerve occurs when a lesion around the brain—such as a tumor or bony pathology—presses on the optic nerve and hinders with its performance. Over time, optic nerve compression may lead to death of the optic nerve (optic neuropathy). Gradual vision loss or a gradual worsening in vision is the most common symptom of optic nerve compression. Imaging studies can verify that a tumor or bone is pressing on the optic nerve. Read more on optic neuropathy at UPMC.
Endoscopy in the treatment of optic nerve compression.
For most patients, the best treatment is to surgically remove whatever is pressing on the optic nerve. Endoscopic surgery through the nose (endonasal approach, EEA), is one treatment used to decompress the optic nerve. With this procedure, the tumor can be removed and the bony canal can be opened to relieve compression on the nerve. EEA is a minimally invasive technique with no incisions, no disfigurement to the patient, and a faster recovery time. Read more on EEA at UPMC.
Podcast: NMO-IgG predicts the outcome of recurrent optic neuritis
Dr. Beau Bruce interview Dr. Brian G. Weinshenker, Professor of Neurology from the Mayo Clinic about his team's paper on NMO-IgG predicts outcome of recurrent optic neuritis. Listen to the podcast at Neurology.
Primary Open-Angle Glaucoma: Diagnosis.
Computer-based study of the optic nerve head and retinal fiber is the best method for determining changes related to glaucoma due to optic nerve pathology. See National Guideline Clearinghouse major recommendations.
Diagnosis of optic neuritis in multiple sclerosis (MS).
Optic neuritis, marked by sudden and painful loss of vision in one eye, is a relatively common presenting symptom of MS. An examination by an ophthalmologist is recommended for any individual presenting with acute visual impairment, with or without pain. On confirmation of a diagnosis of optic neuritis, the ophthalmologist should discuss the possible existence of MS with the individual, and provide further referral to a neurologist. See National Guideline Clearinghouse major recommendations.
Optic neuropathy caused by radiation.
Vision problems may be caused by a whole host of optic nerve neuropathies, including radiation, chemotherapy, nerve compression, or ischemia (reduced blood supply). Radiation-induced optic neuropathy (RON) is a rare but serious complication of radiation therapies used to treat a variety of tumors of the skull base and surrounding tissue. There is typically delayed visual impairment after radiation therapy. Treatment with corticosteroids may be helpful, although complications such as optic atrophy (tissue death) may develop with permanent vision loss. See National Guideline Clearinghouse major recommendations.
Optic neuropathy due to trauma.
Traumatic optic neuropathy (TON) may lead to blindness. The injury is typically from head trauma without direct impact on the globe or retina. Diagnosis of TON is often delayed as patients may exhibit depressed levels of consciousness. Visual loss due to trauma can be evaluated with CT scans of the area. MR (magnetic resonance) images have been shown to be more useful for detecting optic nerve edema (swelling) or avulsion (tear). Treatment with steroids and surgery remain controversial and show no clear-cut advantages. See National Guideline Clearinghouse major recommendations.
Abstract: Fellow eye changes in optic neuritis correlate with the risk of multiple sclerosis.
Early central nervous system (CNS) inflammation is associated with multiple sclerosis (MS). In patients with unilateral (in one eye) optic neuritis (ON), the clinically unaffected (fellow) eye may be a measure of the condition of normal-appearing white matter in CNS. This study aimed to find a relationship between electrophysiological findings in the fellow eye of ON patients, and the risk of conversion to MS. The researchers found that fellow eye changes as measured using multifocal visual evoked potentials (mfVEP) correlate with the risk of developing MS down the road. Read the abstract at PubMed.
Abstract: Anti-VEGF bevacizumab (Avastin) for radiation optic neuropathy.
The purpose of this study was to evaluate bevacizumab (Avastin) treatment for radiation optic neuropathy (RON). A patient with decreased vision due to RON was given intravitreal (in the vitreous body of the eye) bevacizumab. The optic nerve was observed using various ophthalmologic tests. Within one week, the patient's vision improved to 20/20. At six weeks, there was a reduction in optic disk hemorrhage and edema. The study found that intravitreal bevacizumab was well tolerated and effective in treating RON with no associated ocular or systemic side effects. Read the abstract at PubMed.
Abstract: Feigned visual loss misdiagnosed as occult traumatic optic neuropathy: diagnostic guidelines and medical-legal issues.
Feigned vision loss (malingering) may actually be at play in the diagnosis of occult (hidden or unknown cause) traumatic optic neuropathy in some patients. Diagnostic guidelines are available to differentiate between feigned vision loss and true traumatic neuropathy. The researchers explain why the term occult optic neuropathy is inaccurate and misleading, and may have medical-legal consequences. Read the abstract at PubMed.
Abstract: "Phosphene": early sign of vascular compression neuropathy of the optic nerve.
Phosphenes are flashes of light seen by patients with ophthalmological disease and in those without eye problems. In this report, a 68-year-old woman experienced phosphenes in the left visual field due to compression of the right optic nerve by an aneurysm of a nearby artery. After treating the aneurysm, the phosphenes decreased dramatically. The researchers concluded that phosphenes may be an important early sign of vascular compression neuropathy of the optic nerve. Read the abstract at PubMed.
Abstract: Endoscopic orbital and optic nerve decompression.
Endoscopic decompression of the orbit (bony eye socket) has become the preferred surgical treatment for many patients with orbital manifestations of Grave's disease, including proptosis (protrusion of the eyeballs) and optic neuropathy. Endoscopy provides excellent visualization and allows for safe and thorough decompression of bony pathology around or near the skull base. While the usefulness of orbital decompression is well established, the role of optic nerve decompression remains in question. Read the abstract at PubMed.
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