Ocular neuritis is characterized by inflammation. It can cause vision symptoms and pain.

In many cases, the condition recovers without treatment. There are options, such as steroids, that might be considered if the inflammation does not subside on its own.

It is estimated that one to five in every 100,000 people experience ocular neuritis, depending on ethnicity and geography, according to the American Academy of Ophthalmology. (Learn More)

When this issue is present, pain and vision changes can occur. It is possible for certain complications to happen, but most people recover eventually. (Learn More)

It is important to get an accurate diagnosis and identify the underlying cause. (Learn More) This will determine the best treatment option.

People often recover on their own without any specific medical treatment. However, some people receive steroids to alleviate the associated inflammation. (Learn More) A doctor must determine what is best for the specific case.

What Is Ocular Neuritis?

Ocular neuritis is a condition characterized by inflammation of the optic nerve. This can cause vision symptoms that interfere with a person’s ability to see.

The optic nerve is responsible for taking the eye’s visual signals and sending them to the brain. Inflammation there affects this process.

When inflammation is present, it means that chemical messengers and white blood cells are flooding to the area of the optic nerve. The purpose of inflammation is to attack a foreign invader or stimulate healing. In the case of optic neuritis, there may or may not be a known cause.

In most cases, only one eye is affected. However, there are cases where both eyes are affected by this condition. Children and adults can experience it.

Ocular Neuritis Symptoms

Pain is common when someone has ocular neuritis. It occurs in the affected eye and tends to get worse when someone moves their eye. It is often described as a dull ache. The sensation is typically present behind the eye.

Vision loss in the affected eye is possible. Most people experience at least some decrease in their vision. However, for some people, it can be significant since the severity of this symptom varies.

The loss of vision can occur over days or hours. In the weeks or months following the loss of vision, it usually starts to improve. However, for some people, the loss of vision is permanent.

Some people notice a reduction in their visual field. This is side vision.

Some people say that when they move their eyes, they see flickering or flashing lights.

Color vision can also be affected. People might notice that the vividness of colors starts to decrease.

Some people report that when they are very tired or hot, the symptoms get worse. This can result in increased symptom severity when showering or exercising.

The symptoms can also worsen if the condition goes untreated.

old man with vision problems

Causes of Ocular Neuritis

This condition can develop at any age, but most cases are diagnosed in people ranging from age 20 to 40. Women are diagnosed more often than men. In the U.S., this condition is more common in Caucasian people than in other ethnicities.

Doctors do not fully know why people develop this condition. One theory is that someone experiences a viral infection that essentially triggers the immune system to view the optic nerve as a foreign invader so it attacks the nerve.

Certain conditions and medications have been linked to this condition.

  • Multiple sclerosis, a type of autoimmune condition, has a connection with ocular neuritis. Once someone develops ocular neuritis, they have a 50 percent chance of developing MS over their lifetime.
  • Bacterial infections, such as cat-scratch fever, Lyme disease, and syphilis, have all been associated with this condition.
  • Certain viral infections have also been linked, such as mumps, herpes, and measles.
  • Neuromyelitis optica is characterized by recurrent spinal cord and optic nerve inflammation.
  • Certain medications have been linked to this condition, such as certain antibiotics and quinine.
  • Other diseases may also play a role, such as lupus and sarcoidosis.

Getting a Diagnosis

To make an accurate diagnosis, doctors rely on an ophthalmologic examination and clinical findings. They get a patient’s medical history and learn about any current or past medications they have taken. Since certain viruses are linked to this condition, such as measles and mumps, doctors often ask about immunization history.

During the eye examination, the doctor looks at several elements, including the patient’s pupil reactions, peripheral vision, visual acuity, and color vision. This is important since ocular neuritis can affect all of these aspects of vision.

The doctor also needs to examine the optic nerve specifically to look for swelling and inflammation. This is usually done via ophthalmoscopy. This test looks at the fundus of the eye, which includes the optic disc, blood vessels, retina, and choroid structures.

There are different types of ophthalmoscopy, including:

  • Direct. This type requires a darkened room. The doctor shines light through the pupil with an ophthalmoscope. This allows the doctor to see the back of the eye.
  • Indirect. This type requires the person be in a semi-reclined or sitting position. The doctor shines light into the eye and uses a lens that they hold close to the eye. In some cases, the doctor might use a small, blunt probe to apply pressure to the eye. The patient will look in different directions while the doctor examines their eye.
  • Slit-lamp. This type requires the patient to sit down and rest their chin on a support. The doctor uses a slit lamp’s microscope along with a small lens to look at the eye. This test is similar to the direct type, but the doctor uses higher magnification to examine the eye.

Each of these tests take about 5 to 10 minutes. The pupils may be dilated before the tests are performed.

Other testing the doctor may perform includes a brain MRI, blood testing, or a spinal tap. These may be necessary to determine if the person has associated conditions, such as multiple sclerosis.

Treatment Options

An opthamologist is listening to the patient in an exam room.

Recent studies referred to as the Optic Neuritis Treatment Trials changed how doctors approach treating this condition. The studies gave people with the condition oral steroids, intravenous steroids, or a placebo. For several years after administering the drugs, the people were evaluated.

It was determined that intravenous steroids were the most beneficial. This treatment option also appeared to reduce the risk of someone developing multiple sclerosis after having ocular neuritis.

Due to this research, doctors choose a combination of oral and intravenous steroids for their patients. In some cases, they only monitor the person and do not give any medication. It is not recommended that doctors only give oral steroids for ocular neuritis.

Intravenous steroids are typically given for 3 days. After this time, the person may be prescribed oral steroids for approximately 11 days.

When people are taking steroids, it is important to look out for any side effects they may experience. It is especially imperative that people report any pancreatitis or depression symptoms to their doctor. Common side effects include:

  • Mild mood changes.
  • Sleep disturbances.
  • Upset stomach.

Over the course of approximately a week, the visual symptoms that occur with this condition may become worse. For three to eight weeks, they typically stabilize. After this point, a person’s vision may improve gradually.

Depressed woman sitting on a chair in dark room at home. Lonly , sad, emotion concept.

Recurrent Episodes

It is estimated that about 95 percent of people who experience this condition will recover most of their vision. However, this may take up to six months following the onset of ocular neuritis.

Approximately 19 percent of people who experience this condition will have another episode in the same eye within 10 years. During this same time span, about 17 percent of people will have recurrent ocular neuritis, but on their other eye.

Once a person has this condition, the doctor may choose to monitor them for the symptoms of multiple sclerosis due to the link between the two conditions. The doctor might suggest the person get a brain MRI.

People who have experienced ocular neuritis have approximately a 50/50 chance of developing multiple sclerosis in the 10 years following ocular neuritis and the presence of white matter lesions on an MRI.

Prompt Treatment

If someone experiences symptoms of ocular neuritis, they should contact their doctor promptly. It is important to start treatment as soon as possible. It is also imperative to determine the underlying cause.

References

Demyelinating Optic Neuritis. American Academy of Ophthalmology.

Optic Neuritis. Cleveland Clinic.

Optic Neuritis. Columbia University Department of Neurology.

Optic Neuritis. Mayo Clinic.

Optic Neuritis Symptoms. American Academy of Ophthalmology.

Optic Neuritis. Genetic and Rare Diseases Information Center.

Ophthalmoscopy. MedlinePlus.

Optic Neuritis Treatment Trial. U.S. National Library of Medicine.

Optic Neuritis and Neuropathy. All About Vision.