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Key Findings

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  • Papillitis is a form of optic neuritis seen on ophthalmoscopic examination as an inflamed optic nerve head

  • Optic neuritis in children may be idiopathic or associated with multiple sclerosis, acute disseminated encephalomyelitis, Devic disease, or cat-scratch disease

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Clinical Findings

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  • Papillitis (inflammation of the optic disc) results in a swollen/elevated nerve head, blurred optic disc margins, hyperemia of the nerve, optic disc hemorrhages, and dilated retinal veins

  • Optic neuritis is inflammation of the optic nerve and may have the same appearance as papilledema

  • Retrobulbar optic neuritis (inflammation of the optic nerve posterior to the optic disc) has a normal appearing optic disc on examination by ophthalmoscopy

  • Optic neuritis is associated with an afferent pupillary defect (Marcus Gunn pupil), decreased visual acuity, decreased color vision, and it may also have pain with eye movements

  • Other central nervous system (CNS) signs or symptoms may be present so a complete review of systems and neurologic examination are important to complete

  • Optic neuritis can be associated with viral and other infections, vaccinations, and CNS inflammatory demyelination diseases such as acute disseminated encephalomyelitis, multiple sclerosis, and neuromyelitis optica (Devic disease)

  • Neoplasms infiltrating the nerve or orbital infections that compress the optic nerve can also result in optic neuritis

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Diagnosis

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  • Workup includes lumbar puncture and cerebrospinal fluid analysis

  • Serology should target infectious and inflammatory markers

  • Neuromyelitis optica can be diagnosed by detecting neuromyelitis optica immunoglobulin G (IgG)

  • Neuroimaging of the brain and orbits is useful adjunct to the workup

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Treatment

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  • Treatment of the underlying disease

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