Close
New

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

 

Adult Optic Neuritis Differential Diagnoses

  • Author: Erhan Ergene, MD; Chief Editor: Edsel Ing, MD, FRCSC  more...
 
Updated: May 26, 2016
 
 

Diagnostic Considerations

Conditions to consider in the differential diagnosis of optic neuritis (ON) include the following:

  • Neuromyelitis optica
  • Hereditary optic neuropathies
  • Nutritional optic neuropathies
  • Granulomatosis with polyangiitis (Wegener granulomatosis)
  • Necrotizing herpetic retinopathy in persons who are immunocompromised
  • Branch retinal artery occlusion
  • Central retinal artery occlusion
  • Herpes simplex
  • Functional vision loss

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Erhan Ergene, MD Clinical Assistant Professor, Department of Neurology, University of Illinois College of Medicine at Peoria; Medical Director, Comprehensive Epilepsy Program and Clinical Neurophysiology, Illinois Neurological Institute at OSF Saint Francis Medical Center

Erhan Ergene, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Coauthor(s)

Nancy A Machens, APN, CNP Professor of Nursing, Bradley University; Advanced Practice Nurse, Nurse Practitioner, Department of Neurology, Illinois Neurological Institute at OSF Saint Francis Medical Center

Disclosure: Nothing to disclose.

Chief Editor

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

Edsel Ing, MD, FRCSC Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Consulting Staff, Toronto East General Hospital, Canada

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, Canadian Ophthalmological Society, North American Neuro-Ophthalmology Society, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Associate Professor 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, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

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.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the assistance of Ryan I Huffman, MD, with the literature review and referencing for this article.

References
  1. Beck RW, Smith CH, Gal RL, et al. Neurologic impairment 10 years after optic neuritis. Arch Neurol. 2004 Sep. 61(9):1386-9. [Medline].

  2. Beck RW, Gal RL, Bhatti MT, et al. Visual function more than 10 years after optic neuritis: experience of the optic neuritis treatment trial. Am J Ophthalmol. 2004 Jan. 137(1):77-83. [Medline].

  3. Atkins EJ, Biousse V, Newman NJ. The natural history of optic neuritis. Rev Neurol Dis. 2006 Spring. 3(2):45-56. [Medline].

  4. Flanagan P, Zele AJ. Chromatic and luminance losses with multiple sclerosis and optic neuritis measured using dynamic random luminance contrast noise. Ophthalmic Physiol Opt. 2004 May. 24(3):225-33. [Medline].

  5. de Stoppelaar JD. [Bacteria as cause of dental caries]. Tijdschr Ziekenverpl. 1975 Nov 18. 28(23):1094-7. [Medline].

  6. Wingerchuk DM, Lennon VA, Lucchinetti CF, et al. The spectrum of neuromyelitis optica. Lancet Neurol. 2007. 6(9):810-815.

  7. Wingerchuk DM, Lennon VA, Pittock SJ, Lucchinetti CF, Weinshenker BG. Revised diagnostic criteria for neuromyelitis optica. Neurology. 2006 May 23. 66(10):1485-9. [Medline].

  8. Cree B. Neuromyelitis optica: diagnosis, pathogenesis, and treatment. Current Neurology & Neuroscience Reports. Sep/2008. 8(5):427-33.

  9. Kattah JC, Gujrati M. Neuromyelitis optica and autoimmune diseases. Arch Neurol. 2008 Jul. 65(7):995-6; author reply 996. [Medline].

  10. Frederiksen JL, Larsson HB, Henriksen O, Olesen J. Magnetic resonance imaging of the brain in patients with acute monosymptomatic optic neuritis. Acta Neurol Scand. 1989 Dec. 80(6):512-7. [Medline].

  11. CHAMPS Study Group. MRI predictors of early conversion to clinically definite MS in the CHAMPS placebo group. Neurology. 2002 Oct 8. 59(7):998-1005. [Medline].

  12. Optic Neuritis Study Group. The clinical profile of optic neuritis. Experience of the Optic Neuritis Treatment Trial. Optic Neuritis Study Group. Arch Ophthalmol. 1991 Dec. 109(12):1673-8. [Medline].

  13. Optic Neuritis Study Group. Long-term brain magnetic resonance imaging changes after optic neuritis in patients without clinically definite multiple sclerosis. Arch Neurol. 2004 Oct. 61(10):1538-41. [Medline].

  14. Arnold AC. Evolving management of optic neuritis and multiple sclerosis. Am J Ophthalmol. 2005 Jun. 139(6):1101-8. [Medline].

  15. Jacobs LD, Beck RW, Simon JH, et al. Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. CHAMPS Study Group. N Engl J Med. 2000 Sep 28. 343(13):898-904. [Medline].

  16. Beck RW. Optic neuritis: Clinical considerations and the relationship to multiple sclerosis. Neuro-ophthalmology. 1998. 20.1-20.3.

  17. Sorensen TL, Frederiksen JL, Bronnum-Hansen H, Petersen HC. Optic neuritis as onset manifestation of multiple sclerosis: a nationwide, long-term survey. Neurology. 1999 Aug 11. 53(3):473-8. [Medline].

  18. Kountakis SE, Maillard AA, Stiernberg CM. Optic neuritis secondary to sphenoethmoiditis: surgical treatment. Am J Otolaryngol. 1995 Nov-Dec. 16(6):422-7. [Medline].

  19. Monteiro ML, Borges WI, do Val Ferreira Ramos C, Lucato LT, Leite CC. Bilateral optic neuritis in wegener granulomatosis. J Neuroophthalmol. 2005 Mar. 25(1):25-8. [Medline].

  20. Nakamoto BK, Dorotheo EU, Biousse V, Tang RA, Schiffman JS, Newman NJ. Progressive outer retinal necrosis presenting with isolated optic neuropathy. Neurology. 2004 Dec 28. 63(12):2423-5. [Medline].

  21. Rush JA, Kennerdell JS, Martinez AJ. Primary idiopathic inflammation of the optic nerve. Am J Ophthalmol. 1982 Mar. 93(3):312-6. [Medline].

  22. Sanborn GE, Kivlin JD, Stevens M. Optic neuritis secondary to sinus disease. Arch Otolaryngol. 1984 Dec. 110(12):816-9. [Medline].

  23. Selbst RG, Selhorst JB, Harbison JW, Myer EC. Parainfectious optic neuritis. Report and review following varicella. Arch Neurol. 1983 Jun. 40(6):347-50. [Medline].

  24. Lee SB, Lee EK, Kim JY. Bilateral optic neuritis in leprosy. Can J Ophthalmol. 2009 Apr. 44(2):219-20. [Medline].

  25. Siddiqui J, Rouleau J, Lee AG, Sato Y, Voigt MD. Bilateral optic neuritis in acute hepatitis C. J Neuroophthalmol. 2009 Jun. 29(2):128-33. [Medline].

  26. Lee HS, Choi KD, Lee JE, Park HK. Optic neuritis after Klebsiella pneumonitis and liver abscess. J Neuroophthalmol. 2009 Jun. 29(2):134-5. [Medline].

  27. Rizzo JF 3rd, Lessell S. Optic neuritis and ischemic optic neuropathy. Overlapping clinical profiles. Arch Ophthalmol. 1991 Dec. 109(12):1668-72. [Medline].

  28. Lennon VA, Kryzer TJ, Pittock SJ, Verkman AS, Hinson SR. IgG marker of optic-spinal multiple sclerosis binds to the aquaporin-4 water channel. J Exp Med. 2005 Aug 15. 202(4):473-7. [Medline].

  29. Lennon VA, Wingerchuk DM, Kryzer TJ, et al. A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet. 2004 Dec 11-17. 364(9451):2106-12. [Medline].

  30. Beck RW, Trobe JD, Moke PS, et al. High- and low-risk profiles for the development of multiple sclerosis within 10 years after optic neuritis: experience of the optic neuritis treatment trial. Arch Ophthalmol. 2003 Jul. 121(7):944-9. [Medline].

  31. Trobe JD, Sieving PC, Guire KE, Fendrick AM. The impact of the optic neuritis treatment trial on the practices of ophthalmologists and neurologists. Ophthalmology. 1999 Nov. 106(11):2047-53. [Medline].

  32. Pittock SJ, Weinshenker BG, Lucchinetti CF, Wingerchuk DM, Corboy JR, Lennon VA. Neuromyelitis optica brain lesions localized at sites of high aquaporin 4 expression. Arch Neurol. 2006 Jul. 63(7):964-8. [Medline].

  33. Matsushita T, Isobe N, Matsuoka T, et al. Aquaporin-4 autoimmune syndrome and anti-aquaporin-4 antibody-negative opticospinal multiple sclerosis in Japanese. Mult Scler. 2009 Jul. 15(7):834-47. [Medline].

  34. Jarius S, Ruprecht K, Wildemann B, Kuempfel T, Ringelstein M, Geis C, et al. Contrasting disease patterns in seropositive and seronegative neuromyelitis optica: A multicentre study of 175 patients. J Neuroinflammation. 2012 Jan 19. 9(1):14. [Medline].

  35. Koch-Henriksen N, Hyllested K. Epidemiology of multiple sclerosis: incidence and prevalence rates in Denmark 1948-64 based on the Danish Multiple Sclerosis Registry. Acta Neurol Scand. 1988 Nov. 78(5):369-80. [Medline].

  36. Levin LA, Lessell S. Optic neuritis and multiple sclerosis. Arch Ophthalmol. 2003 Jul. 121(7):1039-40. [Medline].

  37. Levin LA, Lessell S. Risk of multiple sclerosis after optic neuritis. JAMA. 2003 Jul 16. 290(3):403-4. [Medline].

  38. Osborne BJ, Volpe NJ. Optic neuritis and risk of MS: differential diagnosis and management. Cleve Clin J Med. 2009 Mar. 76(3):181-90. [Medline].

  39. Warner JE, Lessell S, Rizzo JF 3rd, Newman NJ. Does optic disc appearance distinguish ischemic optic neuropathy from optic neuritis?. Arch Ophthalmol. 1997 Nov. 115(11):1408-10. [Medline].

  40. Tátrai E, Simó M, Iljicsov A, Németh J, Debuc DC, Somfai GM. In vivo evaluation of retinal neurodegeneration in patients with multiple sclerosis. PLoS One. 2012. 7(1):e30922. [Medline]. [Full Text].

  41. Söderström M, Ya-Ping J, Hillert J, Link H. Optic neuritis: prognosis for multiple sclerosis from MRI, CSF, and HLA findings. Neurology. 1998 Mar. 50(3):708-14. [Medline].

  42. Cornblath WT, Quint DJ. MRI of optic nerve enlargement in optic neuritis. Neurology. 1997 Apr. 48(4):821-5. [Medline].

  43. Frederiksen JL, Larsson HB, Olesen J. Correlation of magnetic resonance imaging and CSF findings in patients with acute monosymptomatic optic neuritis. Acta Neurol Scand. 1992 Sep. 86(3):317-22. [Medline].

  44. Hickman SJ, Toosy AT, Jones SJ, et al. A serial MRI study following optic nerve mean area in acute optic neuritis. Brain. 2004 Nov. 127:2498-505. [Medline].

  45. Ergene E, Rupp FW Jr, Qualls CR, Ford CC. Acute optic neuritis: association with paranasal sinus inflammatory changes on magnetic resonance imaging. J Neuroimaging. 2000 Oct. 10(4):209-15. [Medline].

  46. Ormerod IE, McDonald WI, du Boulay GH, et al. Disseminated lesions at presentation in patients with optic neuritis. J Neurol Neurosurg Psychiatry. 1986 Feb. 49(2):124-7. [Medline].

  47. Nielsen K, Rostrup E, Frederiksen JL, et al. Magnetic resonance imaging at 3.0 tesla detects more lesions in acute optic neuritis than at 1.5 tesla. Invest Radiol. 2006 Feb. 41(2):76-82. [Medline].

  48. Pittock SJ, Lennon VA, Krecke K, Wingerchuk DM, Lucchinetti CF, Weinshenker BG. Brain abnormalities in neuromyelitis optica. Arch Neurol. 2006 Mar. 63(3):390-6. [Medline].

  49. Diem R, Molnar F, Beisse F, Gross N, Drüschler K, Heinrich SP, et al. Treatment of optic neuritis with erythropoietin (TONE): a randomised, double-blind, placebo-controlled trial-study protocol. BMJ Open. 2016 Mar 1. 6 (3):e010956. [Medline].

  50. Collongues N, de Seze J. An update on the evidence for the efficacy and safety of rituximab in the management of neuromyelitis optica. Ther Adv Neurol Disord. 2016 May. 9 (3):180-8. [Medline].

  51. Kim SH, Kim W, Park MS, Sohn EH, Li XF, Kim HJ. Efficacy and safety of mitoxantrone in patients with highly relapsing neuromyelitis optica. Arch Neurol. 2011 Apr. 68(4):473-9. [Medline].

  52. Watanabe S, Nakashima I, Misu T, Miyazawa I, Shiga Y, Fujihara K. Therapeutic efficacy of plasma exchange in NMO-IgG-positive patients with neuromyelitis optica. Mult Scler. 2007 Jan. 13(1):128-32. [Medline].

  53. Ruprecht K, Klinker E, Dintelmann T, Rieckmann P, Gold R. Plasma exchange for severe optic neuritis: treatment of 10 patients. Neurology. 2004 Sep 28. 63(6):1081-3. [Medline].

  54. McKinney AM, Lohman BD, Sarikaya B, Benson M, Benson MT, Lee MS. Accuracy of routine fat-suppressed FLAIR and diffusion-weighted images in detecting clinically evident optic neuritis. Acta Radiol. 2013 Feb 5. [Medline].

  55. Wilhelm H, Schabet M. The Diagnosis and Treatment of Optic Neuritis. Dtsch Arztebl Int. 2015 Sep 11. 112 (37):616-26. [Medline].

Previous
Next
 
A case of acute optic neuritis. A. 1.5 Tesla, contrast-enhanced spin echo T1-weighted, fat-suppressed coronal MRI through the orbits shows enlargement and contrast enhancement of the left optic nerve in the retrobulbar portion (arrow). B. Coronal spin echo T1-weighted, fat-suppressed MRI of the same patient shows enlargement and contrast enhancement of the nerve in a parasagittal oblique section (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.