These are acute or degenerative lesions of the optic nerve.
We distinguish:
– papillitis affecting the anterior part of the optic nerve,
– retrobulbar optic neuritis where the nerve is affected behind the eyeball.
1-Papillitis:
They result in a significant drop in visual acuity, a papilla with hemorrhages or exudates at the back of the eye.
The causes are local-regional infections: sinuses, tonsils, teeth, etc. or general illnesses (diabetes, etc.).
Treatment is based on antibiotics and corticosteroids.
2-Retrobulbar optic neuritis:
Optic neuritis is an inflammation of the optic nerve.
The inflammation may be limited to the optic nerve head, which is the part located in the eyeball: it causes an inflammatory condition of the papilla (papillitis).
In retrobulbar optic neuritis, the inflammation is behind the eyeball.
The main cause of retrobulbar optic neuritis is multiple sclerosis (MS).
Optic neuritis can be due to many other causes: tobacco and alcohol poisoning, vitamin B1 and B12 deficiencies, diabetes, ischemia, tumors, family illness (Leber's disease, etc.), certain viral diseases.
Microbial (syphilis).
Parasitic (toxoplasmosis).
Due to a fungus (Candida Albicans).
Vascular causes (arteriosclerosis for example) or systemic causes (lupus, etc.) are also possible.
Symptoms of the disease:
The onset is often acute; the loss of visual acuity, unilateral, is accompanied by headaches, sometimes some pain when moving the eyeballs.
At the office, the Ophthalmologist:
Will make the diagnosis at the back of the eye which shows either edema, or hemorrhage, or atrophy of the origin of the optic nerve (the papilla).
The fundus may be normal at first but the visual field shows a central scotoma.
Secondarily, the papilla becomes discolored, indicating optic atrophy.
The decrease in visual acuity is severe.
Additional examinations
Diagnostic confirmation will be made by examination of visual evoked potentials and MRI as well as lumbar puncture.
OCT sometimes reveals early signs.
Treatment :
It is that of the cause.
We may propose treatment based on antibiotic therapy if there are signs of infection, antivirals, vitamins such as B1, B6, B12, arterial vasodilators, or even corticosteroids.
Interferon beta and glatiramer acetate have proven their effectiveness in multiple sclerosis (fewer and less severe attacks, improvement of lesions visible on MRI, sometimes less progression of disability).