Optic Neuritis

Optic neuritis is an inflammation of the optic nerve that leads to sudden vision loss, frequently accompanied by pain on eye movement. The optic nerve carries visual signals from the retina to the brain. When it is inflamed, the transmission of the image is disturbed and vision deteriorates noticeably within hours to a few days.

Causes

In most cases this is an autoimmune reaction: the body's own immune system attacks the covering (myelin sheath) of the optic nerve. Common triggers and associations are:

Multiple sclerosis (MS): optic neuritis can be a first sign of MS. In adults there is an increased risk of going on to develop MS. In children this risk is lower.
Neuromyelitis optica (NMO): a further autoimmune condition that preferentially affects the optic nerve and the spinal cord.
Viral infections and vaccinations: the inflammation occasionally appears after a cold, influenza or a vaccination, particularly in children.

Symptoms

Sudden deterioration of vision in one eye (in children often both eyes)
Pain on eye movement
Reduced colour vision, colours look paler or washed out
Visual field defects, particularly centrally
Sometimes flashes of light on eye movement

Differences between children and adults

In children, optic neuritis often takes a different course than in adults: both eyes are more frequently affected at the same time, and an infectious illness often precedes it. The prognosis in children is more favourable overall, and the risk of later MS is lower than in adults.

Sudden Vision Loss, Pain When Moving the Eyes?

If vision gets worse within hours or days, especially with pain during eye movements, a quick evaluation is needed. Call our practice at Zurich main station: we assess the urgency, and Dr. Stefan Langenegger has a focus on neuro-ophthalmology. Outside opening hours, you can reach the Canton of Zurich emergency service at 0800 33 66 55.

Call 044 442 04 05 Emergency: what to do?

Diagnostic work-up

The diagnosis rests on several investigations:

Visual acuity and colour vision testing: both are typically reduced.
Pupil reaction: a relative afferent pupillary defect (RAPD) is an important sign.
OCT (optical coherence tomography): shows changes in the nerve fibre layer.
Visual field testing: reveals characteristic defects.
MRI of the head and orbits: important in order to rule out or confirm MS and to image the optic nerve.
Blood tests and lumbar puncture: in certain cases, to investigate other causes.

Treatment

Many cases improve spontaneously within weeks. Depending on severity and cause, the following measures are used:

Corticosteroids: high-dose intravenous steroids can speed up recovery, though they do not always improve the final outcome.
Treating the underlying condition: with MS or NMO, specific immunomodulatory therapies are necessary.
Long-term care: regular neurological and ophthalmological check-ups are important in order to detect a possible link with systemic conditions early.

In most patients vision recovers largely, but in some a degree of limitation, such as slightly reduced colour vision or reduced contrast sensitivity, persists permanently.

When should you see an ophthalmologist?

See an ophthalmologist without delay if you or your child notice a deterioration of vision within a short period, particularly in combination with eye pain. A rapid assessment is crucial in order to start the right treatment and to rule out serious causes.

Dr. Stefan Langenegger

Treating Ophthalmologist

044 442 04 05