Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Compressive Optic Neuropathy Medication

  • Author: Jonathan W Kim, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Nov 16, 2015
 

Medication Summary

Many cases of compressive optic neuropathy (eg, thyroid ophthalmopathy, orbital pseudotumor, lymphoma, sarcoid) will improve at least transiently with steroid treatment. Intravenous steroids may hasten visual recovery. It may be difficult to withdraw steroid treatment from such patients without deterioration of vision.

Biological agents and immune mediators that target specific aspects of disease pathogenesis may have a role in inflammatory and autoimmune processes causing compressive optic neuropathy. However, the efficacy of these drugs has not been well studied. 

See Thyroid Ophthalmopathy for details of medical treatment.

Next

Corticosteroids

Class Summary

Treatment of compressive optic neuropathy.

Prednisone (Deltasone)

 

Used to suppress inflammatory response in order to reduce compression of optic nerve.

Previous
 
 
Contributor Information and Disclosures
Author

Jonathan W Kim, MD Director of Oculoplastic and Orbital Surgery, Co-director of Ocular Oncology Service, Co-director of Neuro-ophthalmology Service, Department of Ophthalmology, Stanford Medical Center

Jonathan W Kim, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery, North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

Coauthor(s)

Talmadge (Ted) Cooper, MD Clinical Associate Professor, Department of Ophthalmology, Stanford University School of Medicine

Talmadge (Ted) Cooper, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Medical Informatics

Disclosure: Nothing to disclose.

Diana Katherine Lee Georgetown University School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Edsel Ing, MD, FRCSC Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Consulting Staff, Hospital for Sick Children and Sunnybrook Hospital

Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Ophthalmic Plastic and Reconstructive Surgery, Royal College of Physicians and Surgeons of Canada, Canadian Ophthalmological Society, North American Neuro-Ophthalmology Society, Canadian Society of Oculoplastic Surgery, European Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Medical Association, Ontario Medical Association, Statistical Society of Canada, Chinese Canadian Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

Brian R Younge, MD Professor of Ophthalmology, Mayo Clinic School of Medicine

Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

References
  1. Miller NR, Newman NJ, Biousse V. Walsh and Hoyt's Clinical Neuro-Ophthalmology. 6th ed. Lippincott, Williams & Wilkins; 2004.

  2. Schiefer U, Wilhelm H, Hart W. Neuro-ophthalmic presentations of orbital disease. Clinical Neuro-Ophthalmology: A Practical Guide. Wien & New York: Springer; 2007.

  3. Bulters DO, Shenouda E, Evans BT, Mathad N, Lang DA. Visual recovery following optic nerve decompression for chronic compressive neuropathy. Acta Neurochir (Wien). 2009 Apr. 151(4):325-34. [Medline].

  4. Shields AJ, Shields CL, Scartozzi R. Survey of 1264 patients with orbital tumors and simulating lesions: the 2002 Montgomery Lecture, Part 1. Ophthalmology. 2004. 111(5):997-1008. [Medline].

  5. Hodson KE, Bowman RJ, Mafwiri M, et al. Low folate status and indoor pollution are risk factors for endemic optic neuropathy in Tanzania. Br J Ophthalmol. 2011 Oct. 95(10):1361-4. [Medline].

  6. Lee AG, Chau FY, Golnik KC, Kardon RH, Wall M. The diagnostic yield of the evaluation for isolated unexplained optic atrophy. Ophthalmology. 2005 May. 112(5):757-9. [Medline].

  7. Thomas KW, Hunninghake GW. Sarcoidosis. JAMA. 2003 Jun 25. 289 (24):3300-3. [Medline].

  8. Alvarez L, Guañabens N, Peris P, Monegal A, Bedini JL, Deulofeu R, et al. Discriminative value of biochemical markers of bone turnover in assessing the activity of Paget's disease. J Bone Miner Res. 1995 Mar. 10 (3):458-65. [Medline].

  9. Spoor TC. Atlas of Oculoplastic and Orbital Surgery. Informa Healthcare; 2007.

  10. Phillips ME, Marzban MM, Kathuria SS. Treatment of thyroid eye disease. Curr Treat Options Neurol. 2010 Jan. 12 (1):64-9. [Medline].

  11. Verity DH, Rose GE. Acute thyroid eye disease (TED): principles of medical and surgical management. Eye (Lond). 2013 Mar. 27 (3):308-19. [Medline].

Previous
Next
 
Axial MRI taken 3 weeks after the onset of distorted vision in the right eye; visual acuity is reduced to counting fingers at 1 ft. Evidence of optic nerve compression is not seen; disease in the sphenoid sinus is reported.
MRI of same patient as in the image above taken 4 months later. Patient responded well to IV Solu-Medrol, but symptoms returned when steroids were reduced. Large mass compressing the right optic nerve is seen. Biopsy revealed lymphoma.
A 72-year-old man with a moderate decrease in vision in the left eye (20/20 right, 20/25 left). Fundus examination revealed a normal right optic nerve.
Same patient as in image above of a 72-year-old man with a moderate decrease in vision in the left eye (20/20 right, 20/25 left). Fundus examination revealed an atrophic left optic nerve.
Neuroimaging study (MRI of brain and orbits) revealed an extensive meningioma involving the left orbital apex (arrow).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.