Ophthalmology

Optic nerve inflammation

Definition of optic nerve inflammation

The exact name depends on which part of the optic nerve is inflamed. If the inflammation is in the optic nerve head, it is called papilitis. If the inflammation is further back in the optic nerve, it is called retrobulbar neuritis.

When optic nerve inflammation occurs, swelling (edema) of nerve fibers on the optic nerve head develops. Often the diseases also lead to a disturbance of the blood flow, which in turn leads to damage to the optic nerve and impaired vision. This deterioration in vision can lead to blindness. The optic nerve inflammation is usually unilateral.

How common is optic nerve inflammation?

Optic nerve inflammation is one of the most common diseases affecting the retina. Mostly adults between 20 and 45 years of age are affected. Men develop optic nerve inflammation less often than women.

Detecting inflammation of the optic nerve

What are the symptoms of optic nerve inflammation?

If the front area of the optic nerve becomes inflamed (papillitis), the affected person feels a dull feeling of pressure in the back of the eyeball and a severe visual disturbance. Eye movements are painful because the swollen optic nerve cannot easily follow the eye movements and is therefore additionally irritated.
Fever is a frequent accompanying symptom and color perception disorders (color blindness) can occur.
A loss of the center of the field of view is also possible, as a result of which the patient becomes more or less blind.

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Symptoms of optic nerve inflammation
and
Eye pain

How is optic nerve inflammation diagnosed?

If the front part of the optic nerve is affected, the inflammation can be determined during an examination with an ophthalmoscope (ophthalmoscopy).

An inflammation can be seen behind the eyeball but not in the ophthalmoscope and the optic disc appears almost unchanged in the case of optic nerve inflammation because the inflammation is only behind it. The so-called visual field examination shows an extensive loss in the center of the visual field.

The Swinging Flashlight Test shows a disturbed reaction of the pupil to light. For this examination, the pupil of the eye is illuminated in a darkened room with the lamp of the ophthalmoscope for two seconds. Then the light beam is directed to the other eye. When illuminating the diseased eye, a dilatation of the pupil is noticeable, but when switching back to the healthy eye, a pupil constriction is visible.
Damage to the papilla in the case of an inflammation of the optic nerve is only detectable with an ophthalmoscope after 4 to 6 weeks of existence.
For more information on the pupillary difference, see Different sized pupils.

Magnetic resonance imaging (MRI of the brain) can be used to examine the brain for foci of inflammation.

By examining the so-called "visual evoked cortical potential (VECP)", the delay in impulse conduction in the optic nerve that is characteristic of the disease is determined. For this purpose, the potentials of the cerebral cortex caused by flashes of light are measured, separated from the EEG potentials and recorded. If the time until the nerve responds is longer in the comparison of both eyes, damage to the optic nerve, i.e. possible optic nerve inflammation, can be concluded.

A brain tumor, which can also be responsible for damage to the optic nerve, must be excluded with computed tomography (CT).

Find out more about the topic here: Pupillary reflex

Can there be pain with an inflammation of the optic nerve?

Optic nerve inflammation can occur in the context of multiple sclerosis (see below) or a bacterial infection. Other diseases such as lupus erythematosus can also be the cause.
In addition to the typical symptoms such as visual disturbances and visual field loss, the patients also report unpleasant pain. The pain occurs in the affected eye. Since the inflammation can also occur in both eyes simultaneously, the pain can also be perceived in both eyes.
Those affected report pain that is expressed around the eye or that is perceived deep in the head. The pain from the inflammation can also spread and lead to a headache.

The nature of the pain can be very different.
It can be diffuse, dull, throbbing or piercing and can be accompanied by a headache. If nerves other than the optic nerve are affected by the inflammation, for example the nerves that are responsible for eye movements, additional pain can occur if the eyes are moved in different directions. The eyes can also be very sensitive.
Bright light can cause additional irritation due to inflammation and make the pain worse for a short time. The eye can also be sensitive to pain to pressure. Furthermore, heat in the form of hot baths or warm showers can increase the symptoms. Optic nerve inflammation usually heals well on its own. Anti-inflammatory drugs such as cortisone can help and speed up the resolution of the inflammation.

Pain reliever medication such as ibuprofen can also be taken to treat the pain. In most cases, as the inflammation subsides, the pain subsides, and headaches and sensitivity to light also decrease. However, it may take several weeks to months for complete healing. Inflammation of the optic nerve can then recur and be accompanied by similar symptoms. Visual disturbances and pain in the eye should be assessed by a doctor to rule out a more serious underlying disease.
If the symptoms do not improve, it is also advisable to consult a doctor for advice and treatment.

Read more on the topic: Pain behind the eye

Treating optic nerve inflammation

How is optic nerve inflammation treated?

If foci of infection in the brain are the reason for the optic nerve inflammation, high-dose cortisone is advisable. The causal disease is treated with papillitis. If the cause of the retrobulbar neuritis cannot be determined, a check-up with a neurologist, ENT doctor or internist is necessary before effective treatment.

If optic neuritis is severe, treatment with high-dose cortisone is urgent so that vision can be restored more quickly. However, the following other diseases must be ruled out beforehand: tuberculosis, gastric ulcer, diabetes mellitus and high blood pressure.

Is optic nerve inflammation treated with cortisone?

Cortisone is a steroid hormone that is synthesized by the body in the adrenal cortex. The synthetic (artificially) produced cortisone acetate is used for the therapy of various inflammatory diseases. In the body, especially in the liver, it is broken down into the active cortisol and can develop its effectiveness.

Cortisone is therefore also used to treat optic nerve inflammation. As an anti-inflammatory drug, it slows down the inflammatory process and supports the body in the healing process. Cortisone can be administered orally or, in acute cases, given intravenously in high doses and can thus act more quickly.
Treatment with cortisone will reduce the inflammation faster, but in the case of underlying multiple sclerosis, the disease cannot be stopped. It helps to stop the inflammation in the short term, but because of the serious side effects, cortisone treatment should be carefully considered. Side effects include weight gain, osteoporosis, water retention, and general immune deficiency. In the context of Cushing's syndrome, the body image changes. The patient gains weight, there is a redistribution of fat and in the long run the muscle mass shrinks. These additional symptoms should be considered when using cortisone treatment.

Preventing optic nerve inflammation

What are the causes of optic nerve inflammation?

Especially in children, the cause of an optic nerve inflammation is usually a general infection. If the optic nerve head becomes inflamed (papillitis), the cause cannot be determined in 70% of cases.

Inflammatory processes are possible in infectious diseases such as Lyme borreliosis, malaria or syphilis (syphilis). Autoimmune diseases (facial rose, polychondritis, Crohn's disease, ulcerative colitis, panarteritis nodosa, Wegener's disease) can also cause inflammation of the optic nerve head.

Multiple sclerosis is most common for inflammation of the posterior part of the optic nerve. The onset of multiple sclerosis is announced by such an inflammation in 30 to 40% of cases.

Read more on the topic: Optic nerve inflammation in multiple sclerosis

Conversely, retrobulbar neuritis only occurs in every fifth patient with multiple sclerosis. Another cause of retrobulbar neuritis can be sinus inflammation.

Read more on the topic: Optic nerve inflammation causes

Course of an optic nerve inflammation

What is the course of an optic nerve inflammation?

In 20 to 40% of cases, neuritis (inflammation of the nerve) turns into encephalitis, as the structures are very close together and the optic nerve is part of the brain in terms of developmental history.

What is the prognosis for optic nerve inflammation?

Especially in patients with multiple sclerosis, vision usually improves during therapy. Before visual acuity recovers, there may be a further temporary decrease during the illness. A failure of the central field of view rarely persists. In 95% of those suffering from optic nerve inflammation, a clear improvement in vision can be seen after one year. Often, however, a relapse can be observed, in 15% of cases it occurs within 2 years.
In some cases, optic nerve atrophy occurs after the inflammation subsides.

How long does optic nerve inflammation last?

Optic nerve inflammation can develop very quickly and does not always show the same course and symptoms.

If the inflammation is well advanced, it can last up to two weeks before spontaneous improvement appears. The reduction of the inflammation can be accelerated by targeted treatment with anti-inflammatory drugs such as Corstion. However, it can take several weeks or even months for all symptoms to go away.
However, if the inflammation is very severe or if the optic nerve is damaged as part of an autoimmune disease such as multiple sclerosis, some symptoms can persist. The damage that remains depends on the severity of the inflammation and how it has spread to the eye. To shorten the duration of inflammation, it is important that the patient does not ignore the first signs and see a doctor early on. This can initiate the appropriate therapy and thus avoid serious complications.

Further questions about optic nerve inflammation

Is optic nerve inflammation typical in multiple sclerosis?

Multiple sclerosis is an autoimmune disease in which the immune system attacks the medullary sheaths of the central nervous system.

It is a progressive chronic inflammatory disease. The body's own immune cells attack healthy nerve tissue and destroy it. So far there is no therapy that can stop this destruction.
In MS, the optic nerve of the eye is also attacked. The optic nerve inflammation is also called optic neuritis or neuritis nervi optici in medical terminology. It is often the first symptom of multiple sclerosis. The optic nerve inflammation initially manifests itself with pain in the eye area. Many patients report the pain felt behind the eyeball.
The nerve is finally demyelinated and thus damaged to such an extent that visual disturbances eventually occur. These visual disturbances manifest themselves as an increasingly blurred field of vision. Individual areas of the field of vision can ultimately fail completely. In addition, the contrast and color perception can also be reduced. In addition to these typical symptoms, headaches can also occur more frequently.

Some patients also report experiencing flashes of light. These complaints are also part of the symptoms of optic nerve inflammation and are signs of damage to the optic nerve. Furthermore, double vision can occur, which is an indication that the visual pathway on one side of the brain is also affected by the inflammation.
The acute inflammation lasts for about one to two weeks and then suddenly stops. However, the nerve is often damaged, especially if it is caused by multiple sclerosis. The symptoms will therefore no longer improve and the extent of the damage that remains depends on the severity of the nerve damage. The optic nerve inflammation often recurs with a new flare-up of multiple sclerosis.
With every further inflammation or worsening of the disease, the optic nerve becomes more damaged. This can eventually lead to complete blindness. Since an inflammation of the optic nerve usually heals on its own, treatment for multiple sclerosis was aimed at stopping the attack and slowing the progression of the nerve damage.This can also alleviate the symptoms. Anti-inflammatory drugs achieve short-term success, but the underlying disease MS cannot be stopped in the long term.

Read more on the topic: Optic nerve inflammation in MS

Further information on MS: