eMedicine Specialties > Ophthalmology > Optic Nerve

Optic Neuropathy, Compressive: Treatment & Medication

Author: Talmadge (Ted) Cooper, MD, Adjunct Clinical Associate Professor, Department of Ophthalmology, Stanford Medical School
Contributor Information and Disclosures

Updated: Sep 10, 2007

Treatment

Medical Care

  • Corticosteroids are useful in compressive optic neuropathy caused by inflammation and thyroid ophthalmopathy.
  • Symptoms from other causes of compressive optic neuropathy also may improve with use of corticosteroids.
  • Radiation therapy often is appropriate for malignant lesions and may benefit intracanalicular and possibly intraorbital meningiomas.
  • A favorable response to treatment with corticosteroids should not be considered as confirmation of a diagnosis until good quality MRIs and CT scans are obtained.
  • A practical approach for those cases in which the MRI and/or CT scan strongly indicates a meningioma (both intraorbital and intracanalicular) is to monitor the patient with serial visual acuity measurements and field testing. If visual loss progresses, consider treatment with radiation, and, if growth continues, then also consider surgery.

Surgical Care

  • Consider surgical excision or decompression as a treatment option when orbital tumors compress the optic nerve. Well circumscribed apical optic nerve tumors (eg, cavernous hemangioma) may require an orbitocranial approach.
  • The definitive procedure for optic neuropathy of Graves disease is orbital decompression. Although advocates of steroids and radiation exist, decompression is the best and most assured way of reversing the compression aspect of this disorder.
  • Optic canal decompression for tumors in the intracanalicular area is extremely risky and not uncommonly results in the loss of any remaining vision, unless the tumor has a large exophytic component.
  • If the tumor is intimately involved with the optic nerve, as often is the case with nerve sheath meningiomas, surgical removal often results in further loss of vision. This is thought to be due to a compromise of the shared blood supply.

Consultations

Patients with compressive optic neuropathy should be managed in consultation with a neuro-ophthalmologist or an orbital surgeon whenever possible.

Activity

Prescribe polycarbonate safety glasses to patients with compressive optic neuropathy to protect the vision in the unaffected eye.

Medication

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.

See Thyroid Ophthalmopathy for details of medical treatment.

Corticosteroids

Treatment of compressive optic neuropathy.


Prednisone (Deltasone)

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

Adult

60-120 mg PO qd
(Methylprednisolone 250 mg IV qid or higher doses in cases of severe visual loss)

Pediatric

Not established

Coadministration with estrogens may decrease prednisone clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics

Documented hypersensitivity; viral infection; peptic ulcer disease; hepatic dysfunction; connective tissue infections; fungal or tubercular skin infections; GI disease

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use

More on Optic Neuropathy, Compressive

Overview: Optic Neuropathy, Compressive
Differential Diagnoses & Workup: Optic Neuropathy, Compressive
Treatment & Medication: Optic Neuropathy, Compressive
Follow-up: Optic Neuropathy, Compressive
Multimedia: Optic Neuropathy, Compressive
References
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References

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

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

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

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

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Further Reading

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Keywords

compressive optic neuropathy, optic neuropathies, optic neuritis, optic nerve, optic nerve compression, optic atrophy, vision loss, thyroid ophthalmopathy

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Contributor Information and Disclosures

Author

Talmadge (Ted) Cooper, MD, Adjunct Clinical Associate Professor, Department of Ophthalmology, Stanford Medical School
Talmadge (Ted) Cooper, MD is a member of the following medical societies: American Academy of Ophthalmology and American College of Medical Informatics
Disclosure: Nothing to disclose.

Medical Editor

Edsel Ing, MD, FRCSC, Assistant Professor, Department of Ophthalmology & Vision Sciences, University of Toronto, Sunnybrook and Women's Health Sciences Center, Toronto East General Hospital
Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, Canadian Medical Association, Canadian Ophthalmological Society, and North American Neuro-Ophthalmology Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
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, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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