eMedicine Specialties > Ophthalmology > Optic Nerve

Optic Neuritis, Adult: Follow-up

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
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
Contributor Information and Disclosures

Updated: Jul 30, 2009

Follow-up

Further Inpatient Care

  • Patients with neuromyelitis optica (NMO) often require supportive care, as they are prone to many complications, such as deep venous thrombosis, pulmonary embolism, urinary tract infection, decubiti, and contractures related to the myelopathy. Mechanical ventilation may be needed due to respiratory compromise.

Further Outpatient Care

  • Patients should receive follow-up care as needed.

Complications

  • Loss of vision from optic neuritis may be permanent.
  • Patients with NMO may experience loss of vision as well as residual neurological deficits related to myelopathy.

Prognosis

  • In contrast to ischemic optic neuropathies and compressive optic neuropathies, a gradual recovery of visual acuity with time is characteristic of ON.44 For most patients with ON, visual function begins to improve 1 week to several weeks after onset even without any treatment. However, permanent residual deficits in color vision and contrast and brightness sensitivity are common.45
  • Final visual outcome may be better in patients with an isolated episode of ON compared to those patients who eventually develop MS.
    • Up to 75% of female patients and 35% of male patients initially presenting with ON ultimately develop MS.46,47,48
    • Patients with silent demyelinative lesions elsewhere in the brain, observed on MRI performed at the initial presentation, are more likely to develop definite MS in the long term than patients with isolated ON. In addition, patients who have recurrent episodes of ON may be more likely to develop MS.
    • In patients with normal findings on MRI, a 16% risk of progression to clinically definite MS exists at 5-year follow-up.
  • Most patients with relapsing NMO have an aggressive form of the disease that is associated with frequent and severe exacerbations and poor prognosis.

Patient Education

  • Finding professional help early in the disease is important.
  • For excellent patient education resources, visit eMedicine's Muscle Disorders Center. Also, see eMedicine's patient education article Multiple Sclerosis.

Miscellaneous

Medicolegal Pitfalls

  • Attempting to diagnose MS following ON is important.
 
Acknowledgments

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



More on Optic Neuritis, Adult

Overview: Optic Neuritis, Adult
Differential Diagnoses & Workup: Optic Neuritis, Adult
Treatment & Medication: Optic Neuritis, Adult
Follow-up: Optic Neuritis, Adult
Multimedia: Optic Neuritis, Adult
References
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References

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

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

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

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

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

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

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

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

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

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

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

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

  13. 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. Jul 2006;63(7):964-8. [Medline].

  14. 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. Jul 2009;15(7):834-47. [Medline].

  15. 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. Nov 1988;78(5):369-80. [Medline].

  16. 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. Jul 2003;121(7):944-9. [Medline].

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

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

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

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

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

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

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

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

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

  26. 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. Aug 15 2005;202(4):473-7. [Medline].

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

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

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

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

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

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

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

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

  35. 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. Feb 2006;41(2):76-82. [Medline].

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

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

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

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

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

  41. 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. Jan 2007;13(1):128-32. [Medline].

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

  43. 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. Sep 28 2000;343(13):898-904. [Medline].

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

  45. 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. Jan 2004;137(1):77-83. [Medline].

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

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

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

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Further Reading

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Keywords

adult optic neuritis, ON, optic nerve, multiple sclerosis, MS, neuromyelitis optica, NMO

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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.

Medical Editor

Edsel Ing, MD, FRCSC, Assistant Professor, Department of Ophthalmology & Vision Sciences, University of Toronto: Consulting Staff, Toronto East General Hospital
Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American College of Physician Executives, American Society of Contemporary Ophthalmology, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, North American Neuro-Ophthalmology Society, and Royal College of Physicians and Surgeons of Canada
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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