Eye Care and Vision
Optic Neuritis: Causes, Symptoms, and Treatment
Optic neuritis is a medical condition that causes inflammation and swelling of the optic nerve. Symptoms can include vision loss and eye pain.
Optic neuritis can be an early sign of multiple sclerosis. Other autoimmune conditions, medications, and infections can also cause the optic nerve to swell.
Optic neuritis may not need treatment, but it can take time to heal. Most people recover from optic neuritis within 1 year.
Vision changes can be scary, especially if you’ve never experienced them before. Many things can cause changes in your vision. But if you also have pain with eye movement and blurred vision, it could be optic neuritis. In this article, we discuss the causes, symptoms, diagnosis, and treatment of optic neuritis.
Optic neuritis is an eye condition that causes inflammation and swelling of the optic nerve. The optic nerve is located at the back of your eyeball. It connects your eye to your brain and allows you to see.
When the optic nerve is swollen and inflamed, it has trouble sending signals from your eye to your brain. This leads to vision changes and eye pain. It’s similar to a short in television wiring — the picture (what you see) gets blurry.
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There are four types of optic neuritis:
Retrobulbar neuritis
Papillitis
Perineuritis
Neuroretinitis
The difference between these types depends on where the swelling and inflammation occurs along the optic nerve. Retrobulbar neuritis is the most common type. In this type, swelling develops behind the optic nerve disc, which is the beginning part of the optic nerve.
The type of optic neuritis you have may be a clue to what’s causing swelling and inflammation in your optic nerve.
Optic neuritis is a rare condition. Both children and adults can develop it, but teens and younger adults are more likely to get the condition. Females are more likely to develop it than males. Optic neuritis is often linked to multiple sclerosis (MS), an autoimmune disease that affects the brain and spinal cord. But there are other causes as well.
Optic neuritis develops when your immune system attacks your optic nerves. This causes optic nerve swelling and inflammation. Medical conditions, infections, and medications can all trigger your immune system to attack your optic nerve. Here’s a closer look at the major causes of optic neuritis.
Some medications can cause optic nerve swelling. See if your medication is on this list.
Beyond optic neuritis. Learn how autoimmune conditions can impact your eye health.
Have more questions about your vision? Our vision and eye center has the answers you need.
Optic neuritis, specifically retrobulbar neuritis or papillitis, is a common symptom of multiple sclerosis (MS). Multiple sclerosis is an autoimmune condition that affects your brain and spinal cord. In fact, optic neuritis is often the first sign someone has MS. About half of people will develop multiple sclerosis within 15 years of an optic neuritis episode. But not everyone who experiences optic neuritis will develop MS. And not everyone with MS will experience optic neuritis.
People with other types of autoimmune conditions are also at higher risk for developing optic neuritis. It can be a symptom of these autoimmune conditions:
Neuromyelitis optica (also known as Devic’s disease)
Paraneoplastic syndromes (an abnormal immune response to cancer)
Not everyone with these conditions will develop optic neuritis. It’s not clear why some people with autoimmune conditions develop swelling and inflammation of the optic nerve while others don’t.
Certain infections can also trigger optic neuritis, including:
Shingles (herpes zoster)
Chicken pox (varicella zoster)
Meningococcal infection, such as meningitis
Coxsackie virus infection, such as hand, foot, and mouth disease
Infections tend to trigger perineuritis and neuroretinitis. It’s not clear why some people with these infections develop optic neuritis.
Several medications have also been linked to optic neuritis, including:
Hydroxychloroquine
Isoniazid
Ethambutol
Streptomycin
Linezolid
Sulfamethoxazole-trimethoprim (Bactrim, Septra)
Amiodarone
Methotrexate
Optic neuritis has also been linked to:
Tobacco and nicotine products
Alcohol
Methanol and ethylene glycol
Heavy metal poisoning, including lead poisoning
The most common symptoms of optic neuritis are vision changes and eye pain. Optic neuritis feels like pain in or behind your eye. The pain can get worse when you move your eye.
Optic neuritis symptoms usually develop over hours to days and peak within 2 weeks. Optic neuritis tends to affect one eye at a time, but in rare cases it can affect both eyes.
Specifically, symptoms may include:
Blurry or dim vision, usually in the center of your eye
Complete vision loss (in severe cases)
Eye pain, especially when moving your eyeball
Flashes or flickers of light
Trouble seeing colors correctly, which may appear dull or faded
An ophthalmologist — a medical doctor who specializes in eye conditions — can diagnose optic neuritis with a complete eye exam. This includes:
A dilated eye exam
A pupil light reaction test
Visual acuity testing (checking how well you can read letters from a distance)
The ophthalmologist may also order an MRI of your brain and orbits (eye sockets). This imaging test can show signs of inflammation in your optic nerve and brain. Your healthcare team may also order tests to look for signs of multiple sclerosis, infections, or other conditions that are associated with optic neuritis.
Not everyone needs treatment for optic nerve swelling. Optic neuritis starts to improve without treatment within 2 to 4 weeks. During this healing time, your vision should start going back to baseline, and your eye pain should get better.
Full recovery from optic neuritis can take up to 1 year. Most people recover nearly all of their vision.
When it comes to treatment options, steroids (strong anti-inflammatory medications) may speed up recovery. But they won’t increase your chances of full vision recovery. Steroids can also cause a lot of side effects, like trouble sleeping, mood swings, and high blood sugar. For some people, the risks of steroid treatment may outweigh the benefits.
Your healthcare team may recommend steroids and other treatments if:
You have severe vision loss
Your healthcare team thinks you have multiple sclerosis or neuromyelitis optica
There’s no way to fully prevent optic neuritis. But you can lower your chances of developing optic neuritis by avoiding medications and toxins linked to the condition. If you smoke or use nicotine products, consider smoking cessation treatment. You can also cut back on alcohol intake.
Talk with your healthcare team about your medication list. They may have suggestions for alternative medications. But don’t stop taking your medications without first talking to your healthcare team.
Seek immediate medical care if you experience new vision changes. Vision changes can be a sign of optic neuritis. But they can also be a sign of other eye conditions that could permanently affect your vision. In some cases, vision changes may also be a sign of serious medical conditions, like a stroke. Don’t wait to get help if your vision changes.
Yes, optic neuritis can come back. The chances of it recurring depend on the underlying cause. For example, about 1 in 3 people with multiple sclerosis will get optic neuritis again. Chances are lower when optic neuritis is caused by other conditions.
Yes, optic neuritis can come back. The chances of it recurring depend on the underlying cause. For example, about 1 in 3 people with multiple sclerosis will get optic neuritis again. Chances are lower when optic neuritis is caused by other conditions.
Most people with optic neuritis recover nearly all of their vision within 1 year. But people with very severe optic neuritis may have more lasting vision changes. Rarely, optic neuritis can cause blindness.
Optic neuritis itself isn’t fatal. But optic neuritis can be a symptom of other medical conditions. Some of these conditions can affect your spinal cord and may cause long-term disability and early death.
Most people can fly safely if they have a history of optic neuritis. But pressure changes from flying may worsen other eye conditions that affect the optic nerve. Talk with your eye doctor before flying if you have a history of optic neuritis or another condition that affects your optic nerve.
Optic neuritis is inflammation of the optic nerve that causes vision loss and eye pain. It can be a sign of multiple sclerosis, but it’s also linked to other medical conditions, infections, and medications. Although symptoms can be frightening, optic neuritis usually gets better within months to a year. Most people will recover their vision.
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