Optic neuritis is a common ophthalmic “inflammatory” condition.
Although common, it is not well known to most people. Even patients who suffer from optic neuritis often do not think that it is an “inflammatory” condition, so why not get rid of the inflammation?
It’s not that simple. Optic neuritis is a common neuro-ophthalmology disease and a common blinding eye disease, so it should be taken seriously: if both eyes experience subacute vision loss at the same time, the visual impairment is aggravated for more than 14 days, and the vision does not recover within six months, then it is likely to lead to blindness.
What factors can cause optic neuritis
In the United States, the incidence of optic neuritis is about 1/100,000 to 5/100,000, and in Denmark it is about 4/100,000 to 5/100,000. In China, there are no exact statistics, some people count about 2/100,000 to 3/100,000. Many causes can cause optic neuritis. The main ones include.
1. systemic infectious diseases: common in viral infections such as influenza, herpes zoster, measles, mumps, syphilis and AIDS; bacterial infections such as pneumonia, encephalitis, meningitis and tuberculosis; autoimmune diseases such as demyelinating disease; also seen in granulomatous diseases as well as metabolic disorders and toxicity: the former such as diabetes, pernicious anemia, vitamin B1 or B12 deficiency, the latter such as tobacco, alcohol The former such as diabetes, pernicious anemia, vitamin B1 or B12 deficiency, and the latter such as tobacco, alcohol, methanol, lead, arsenic and the drug quinine. Nutritional diseases can also cause is optic neuritis. In 1993, it was reported that the average daily caloric intake of the Cuban population fell to 1863 calories, only 65% of the 1989 level, and the average daily protein intake fell from 77 grams to 46 grams. In the spring and summer of 1993, an epidemic of optic neuritis broke out in Havana and the eastern provinces, with as many as 40,000 people suffering from the disease by June of that year. Patients gradually lost their vision after the onset of the disease, and some of them also developed diseases of the limb muscles.
2. Local focal infections.
① Intraocular inflammation. Commonly seen in retinal chorioretinitis, uveitis, and sympathetic uveitis, all of which can spread to the optic disc and cause intraglomerular optic neuritis.
② Orbital inflammation. Orbital osteochondritis can spread directly to cause retrobulbar optic neuritis.
(iii) Inflammation of adjacent tissues. For example, sinusitis can cause optic neuritis.
④ Focal infection. Such as tonsillitis and dental caries can also cause.
Optic neuritis also has its “likes and dislikes”
As with most diseases, optic neuritis has its “favorites”.
1. Women. Women are more likely to have optic neuritis, especially those between the ages of 18 and 49. Among patients with optic neuritis, there are about three times more women than men with optic neuritis.
2. Patients diagnosed with multiple sclerosis (MS). People diagnosed with multiple sclerosis are at high risk for optic neuritis. Optic neuritis is often the first manifestation of MS. Optic neuritis can either be the first symptom (1/4) of multiple sclerosis (MS) or alone, or secondary to the course of the disease. MS occurs during the course of the disease in 8.7% of patients with optic neuritis, and this rate increases every year (30% at 5 years of follow-up; up to 58% at 15 years of follow-up). Of these, only a few cases resolved spontaneously. Long-term follow-up shows that 2/3 of women and 1/3 of men with optic neuritis eventually develop MS, and the risk of developing MS after an episode of optic neuritis is statistically high, ranging from 13% to 58%.
There is no authoritative data to prove that women with a sweet tooth are more likely to develop optic neuritis. The reason for this is that the metabolism of sugar in the body requires the consumption of vitamin B1, and vitamin B1 deficiency may be an important cause of optic neuritis. However, it is certain that a sweet tooth is not good for health.
Tips: Health Tips
1. Patients with optic neuritis should be aware of the risk of multiple sclerosis. For patients with optic neuritis, MRI is an important adjunctive test that can help determine if there is a combination of MS and rule out other lesions.
2, Risk factors for the development of MS in optic neuritis: single or multiple white matter lesions on brain MRI; having had atypical neurological signs; relapses or a family history of MS.
3. Even if there is a brain lesion, only 50% of patients have clinical manifestations of MS.
What symptoms to be alerted
The causes of optic neuritis are complex, and if not treated promptly, it may cause irreversible blindness. Therefore, it is important to pay sufficient attention to the following conditions in our “window of the soul”: 1.
1. Young and middle-aged women with rapidly declining vision. The age is usually between 18 and 45 years old, especially for women, and the sudden appearance of rapid vision loss within a few hours or days (common), and this symptom after a week of vision loss to the minimum should be given sufficient attention. This loss of vision can be dramatic and severe.
2. Pain. Pain in the eye or behind the eye, especially when turning.
3. Loss of color vision. Varying degrees of acquired color vision loss, often heavier than vision loss.
4. Temperature-related visual deficits. Occasionally, there is the Uhthoff sign, in which the visual deficit varies with the rise and fall of body temperature. In patients with optic neuritis, the condition worsens when there is a drastic change in the outside temperature. For example, steaming in a sauna, or going from an air-conditioned room to a hot outdoor area may lead to an aggravation of the primary symptoms.
5. Multiple monocular onset. The first onset is mostly in one eye.
6. There may be prior symptoms of viral infection (respiratory or digestive tract). Cold, fever, and exertion may trigger optic neuritis – there may be symptoms such as a cold and fever before the ocular symptoms, or a cold, etc. may also trigger a recurrence or exacerbation of optic neuritis.
7. Neurological abnormalities. There may be transient, self-recovering neurological abnormalities suggestive of undiagnosed MS, such as numbness or weakness of the limbs, unexplained vertigo or loss of balance.
Can optic neuritis be completely cured?
It is entirely possible for a typical patient with optic neuritis to be cured with early, timely treatment and to reduce the likelihood of recurrence. The first step is to treat the cause; for acute patients, the inflammatory response should be controlled early to avoid optic nerve fiber involvement, either by IV methylprednisolone or oral prednisone or prednisolone. Vasodilators and neurotrophic support should also be given. If there is evidence of infection, antibiotics (penicillin, vincristine) may be administered. Currently, although some experts are controversial about the treatment with corticosteroids, the vast majority of experts agree that early application of corticosteroids is beneficial for disease control. Research data from the American Optic Neuritis Treatment Study Group (ONTT) shows that.
1, although hormones do not provide long-term results for the prevention of MS, patients with optic neuritis attacks have a significantly increased risk of MS onset, and patients who underwent their first methylprednisolone shock therapy reduced the incidence of MS, delaying its onset by as much as 2 years.
2. Acute optic neuropathy without cause is mostly treated with hormonal therapy. Although some cases can have self-remission, hormone therapy can lead to faster and more complete recovery.
3. The recovery of vision was faster in the methylprednisolone-treated group than in the oral prednisolone group, but only for the first 2 weeks, and there was no significant difference in the recovery of vision between these two groups and the oral placebo control group after 6 months.
The recurrence rate of typical optic neuritis is about 25%. On the other hand, due to color vision loss, patchy visual field defects, and decreased contrast sensitivity, patients complain of “no longer being as clear as before the onset of the disease” even though their vision has recovered well. In other words, even if the patient’s vision is “restored”, the color vision abnormalities and relative pupillary afferent disorder (RAPD) will persist.
Tips: Tips
1. Sudden changes in body temperature (e.g., sauna), pregnancy, colds, fever, exertion, etc., may trigger an attack of optic neuritis.
2. Long-term application of drugs such as ethambutol, isoniazid and quinine may cause optic neuritis. Some patients have even developed optic neuritis after six months of ethambutol application. In addition, excessive smoking and alcohol can also cause optic neuritis lesions.
3. Patients with a history of tuberculosis (treated with anti-TB drugs) should receive regular ophthalmology-related examinations.