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Neuritis nervi optici
Pain on moving the eye and washed-out colours on one side — sight usually returns, and the urgency lies in the imaging, not in the eye.
Also known as: optic neuritis · retrobulbar neuritis
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
In optic neuritis the optic nerve swells and conducts less well. The picture is characteristic: within hours to a few days sight in one eye grows worse, and moving the eye hurts — as if something were pulling behind it. Almost always the colours lose their strength, red above all, which looks dull or washed out. This difference can be checked at home: look at a red object alternately with one eye and then the other. Those affected are mostly younger adults, more often women. The good news comes first: sight recovers largely over weeks in the great majority of cases, even when the start looks dramatic. The urgency therefore lies not in rescuing vision but in placing it — because optic neuritis is often the first sign of multiple sclerosis, and imaging of the head answers whether that is so. That changes the outlook and opens preventive treatments. It is different when both eyes are affected, when sight collapses severely or does not recover: then other, rarer illnesses are in the room, and they are treated differently.
A red object, one eye covered, compare. The difference is a concrete piece of information for the appointment and helps later to judge the course.
It is not the eye that presses but the question of whether more lies behind. A scan of head and spinal cord answers it and decides about preventive treatment.
A painless loss in later life is more likely an optic nerve infarct. If headache, chewing pain or a tender temple are added, every hour counts.
That vision temporarily worsens in heat or on exertion is known and harmless. Knowing it prevents alarm — and unnecessary avoidance of exercise.
A low level is common and simple to correct. It is no substitute for treatment but is among the things one puts right anyway.
Tingling, numbness, weakness, double vision or unsteadiness that lasted days to weeks and then disappeared. This list is worth more for placing things than any further test.
The most common cause of retinal and choroidal inflammation there is. The scar is often already there from an infection years ago; the eye doctor recognises it at first sight.
High-dose cortisone through the vein speeds recovery by weeks — but it does not improve how well the eye sees in the end. Low-dose cortisone tablets alone raised the rate of further episodes in studies and are therefore not the route. In most people, sharpness of vision largely returns over two to six months, even without treatment. More important than treating the episode is the question of whether an underlying illness is behind it.
The loss of vision develops over hours to days and peaks after about a week — faster points to a vessel blockage. In about nine out of ten there is pain on eye movement, and the pain often comes one to two days before the loss of vision. Recovery begins after two to four weeks and runs over two to six months; in most, sharpness largely returns, while colour vision and contrast often stay slightly worse.
A pulling behind the eye, especially on looking sideways or up. It often precedes the loss of sight by a day or two and is the commonest first sign.
The simplest self-test: look at a red object alternately with each eye. If one side looks paler, greyer or duller, that is a finding to take seriously.
After a hot bath, during exercise or with fever one sees worse for a while and then as before. That is not a relapse but a peculiarity of affected nerve fibres.
The typical picture affects one eye in younger adults. Involvement of both, a very severe loss or an older age do not fit and lead to other considerations.
An earlier tingling, a passing weakness or double vision that went away by itself: such episodes belong to the history and are almost never mentioned.
In people over fifty with sudden loss of sight they serve to separate an arteritis, which is treated quite differently and is urgent.
A marked shortage can damage the optic nerve in its own right — painlessly, on both sides and slowly. A simple value that separates a treatable cause.
A low level is among the circumstances linked with multiple sclerosis. It is simple to measure and simple to correct.
Here vitamin D has a story of its own: a low level goes together in observational studies with more frequent relapses, and treatment runs through cortisone anyway, which attacks bone. Both reasons point the same way — that capsules prevent relapses is not thereby proven.
Important for the distinction: a severe B12 deficiency can damage the optic nerve in just the same way, only more slowly and usually on both sides. It is measured before the cause is written down.
Cortisone through the vein speeds the recovery by weeks — it changes nothing about the outcome after a year. That is one of the places where the benefit belongs honestly named: faster, not better.
Women are affected several times more often, and the link with multiple sclerosis runs through the same distribution. In pregnancy relapses occur less often, in the months afterwards more often.
Optic neuritis is often the first sign of MS. Low vitamin D levels are linked there with more relapses; whether supplementing changes the course is open.
Optic neuritis is often the first sign of MS. Low levels are linked there with more relapses; whether supplementing changes the course is unclear.