REFRAT

Neuritis Optik

Oleh :

Desi Susma Ayu L, S.Ked

Pembimbing :
dr. Rahmat Syuhada, Sp.M
BAGIAN ILMU PENYAKIT MATA
FAKULTAS KEDOKTERAN UNIVERSITAS MALAHAYATI
RS PERTAMINA BINTANG AMIN
BANDAR LAMPUNG
2016

Optic neuritis
Optic neuritis is an inflammation of the optic
nerve
of either one or both eyes,, it either:
i. papillitis: if it restricted to the optic nerve
head.
ii. Retrobulbar: if the inflammation in the back
of the eye.

 Usually unilateral
typically affecting young adults 18 45

yrs
More common in female
Incidence 1-5 per 100,000 per year

Etiology
A. Idiopathic or May be due to :
B. Autoimmune disorder : the immune
system attack the myelin sheath of the
optic nerve, which become swolled &
inflamed, like what happen in :
i.

Multiple sclerosis

ii. Neuromyelitis optica

C. Infections :
i.

Bacterial

ii. Viral

Changes in white matter in

Multiple sclerosis

Etiology
D. Ischemic : the optic nerve is infarcted due to occlusion
or decrease perfusion of posterior ciliary vessels, it
either:

Temporal arteritis

Non artretic: diabetes, hypertension, atherosclerosis.

Arteritic: temporal arteriris which is an inflammation
of the lining of the arteries within the skull.
E. Toxins : exogenous , endogenous
F. Some drugs e.g. ethambutol
G. Leber's hereditary optic neuropathy
H. Radiotherapy to the head

Anterior ischemic neuropathy

Types

Acute

Papillitis

Chronic

retrobulbar

Alcohol
ambylopia

Tobacco
ambylopia

Acute optic neuritis

Symptoms

Sudden visual loss

Impaired color vision varry from

blurring up to complete blindness.

Impaired contrast sensetivity

Patient see objects as it washed
out or cloud infront.
Also complain of spots, sparkles &
loud noise.

Pain in case of retrobulbar

neuritis worsened by eye

movement.

Diagnosis & Signs

In papillitis
optic dis
k
swelling

In retrobu
lbar < no
abnormal
changes

pat h y
o
r
u
e
n
sc
emic
h
c
s
i
e d di
l
l
In
o
w
le s
-> pa

Diagnosis & Signs

ity
v
i
t
e
ens
s
t
s
ra
Cont
test

Visual acuity
test
Visual acuity is
markedly reduced
up to no perception
of light

Diagnosis & Signs

Color vision
test :
impaired

st : RAPD
e
t
n
o
i
t
c
dont
light rea
e
y
r
y
e
a
ll
i
d
p
e
t
u
c
P
f the affe
o
l
i
p
u
p
The
t
irect ligh
d
o
t
t
c
a
re
direct
in
e
h
t
o
t
but react

Diagnosis & Signs

Visual field test :

Visual field test :
central scotoma
central scotoma

Diagnosis & Signs

MRRI I
M

To diagnose
multiple sclerosis
-> abnormalities
in white matter

Treatments
It usually resolve spontaneously but
treating with steroids speed up vision
recovery.

Prevention

Treatment of underlying causes

( infections, immune disorder, .. )
life style modification in diabetic &
hypertensive patients
Early treatment of vision proplems

Prognosis

Most cases resolve

spontaneously with return of
vision in two weeks to three
months
Some cases show recurrence

Complications

Optic nerve damage

Decrease visual acuity
Side effects of steroids:
immunosuppresion,
Osteoporesis

Chronic optic neuritis

Toxic reaction in optic nerve

Bilateral
symmetrical
Retrobulbar

Symptoms
Painless visual loss
Decrease color
vision

Etiology
Toxins ( tobacco , Lead, methanol, chloramphenicol, quinine) cause damage to
optic nerve & ganglion cells, aggravated by malnutrition, defecincies of protein,
vitamin B12, antioxidant)

Diagnosis
History of :
- exposure to toxins
- malnutrition
Visual field : paracentral
scotoma
Fundus : early no changes ,
late become pale

Treatment
Healthy life style
Stop exposure to toxic substances
Oral or parenteral vitamin B

Prognosis
Vision may improve if the cause is
treated or removed quickly.

Prevention
There are no scientifically validated preventive
measures for optic neuritis. Anecdotal evidence
suggests that maintaining a healthy lifestyle with
proper attention to good nutrition, exercise,
prevention of obesity, maintenance of emotional
health and adequate rest, together with
avoidance of toxins such as cigarettes, may
prevent many diseases. Regular annual eye
exams are critical to maintaining healthy vision.
Early treatment of vision problems can prevent
permanent optic nerve damage (atrophy).