Optic neuritis
| Classification according to ICD-10 | |
|---|---|
| H46 | Optic neuritis |
| ICD-10 online (WHO version 2019) | |
The optic neuritis ( lat. "Optic neuritis"), even retrobulbar , is an inflammatory disease of the optic nerve , ie the second cranial nerve . It must be distinguished from non-inflammatory optic atrophy .
The optic nerve begins in the retina of the eye and merges into the optic tract behind the optic nerve junction . It transmits the optical information from the retina to the visual centers of the cerebrum (primary visual cortex ). Compared to peripheral nerves - including cranial nerves - it is distinguished by the fact that its myelin is not formed by Schwann cells , but by oligodendroglia . That is, its axons behave like axons of the central nervous system. It can therefore become ill with any inflammation of the central nervous system . Optic nerve inflammation is often an early symptom of multiple sclerosis .
Symptoms
The cardinal symptom is deterioration in visual acuity ( loss of vision ) and a central scotoma can occur. In extreme cases, the eye can become completely blind . Headaches in the eye socket , which increase when you turn your gaze and pressure on the eyeballs, are typical. Depending on the cause, only one eye or both can be affected.
Causes and Pathophysiology
The range of causative etiologies is very wide. Often demyelinating diseases such as multiple sclerosis are the cause of optic neuritis. In second place are chronic intoxications (poisoning), such as with alcohol or quinine . Generalized infectious diseases such as diphtheria , typhus , typhus , flu , but also many other diseases of the central nervous system as well as pathogen-related diseases (e.g. meningitis , brain abscess ) are also possible. Some metabolic and internal diseases (extreme arterial hypertension ) are also possible triggers. Inflammation of the orbital tissue or the eye (e.g. uveitis , retinitis ) can affect the optic nerve. Finally, there are also rare hereditary diseases , one of which is inflammation of the optic nerve. Optic neuritis is an obligatory component of optic neuromyelitis .
Investigation methods
Ophthalmological examinations are often without any pathological findings, the fundus of the eye appears normal during ophthalmoscopy ("the (eye) doctor sees nothing and the patient sees nothing"). Papilla swelling only occurs when the foci of inflammation are close to the eye, but this can also occur in completely different diseases ( intracranial pressure ). In the late phase after the acute inflammation has healed, a noticeable pallor can usually remain in the temporal (temple-side) part of the papilla. The diagnosis of a demyelinating disease of the optic nerve can best be made with the help of a contrast-enhanced magnetic resonance tomography (MRT) and it usually shows reductions in the nerve conduction velocity during the examination with the neurophysiological method of evoked potentials .
Course and prognosis
The choice of therapy and, above all, the cause determine the prognosis. Often there is a spontaneous improvement over the course of several weeks to a few months, sometimes even complete recovery of the eyesight.
therapy
Basically, the recognized underlying disease must be treated. About two thirds of optic nerve inflammation in Germany is caused by multiple sclerosis. In these cases the appropriate therapy is indicated to break the inflammatory flare-up. Bacterial infectious diseases are treated with antibiotics that pass through the liquor . Anti-inflammatory therapy with corticosteroids is often attempted.
literature
- Albert J. Augustin: Ophthalmology. 3rd, completely revised and expanded edition. Springer, Berlin et al. 2007, ISBN 978-3-540-30454-8 .
- Franz Grehn: Ophthalmology. 30th, revised and updated edition. Springer, Heidelberg 2008, ISBN 978-3-540-75264-6 .
- Rudolf Sachsenweger (Ed.): Neuroophthalmology. 3rd, revised edition. Thieme, Stuttgart et al. 1983, ISBN 3-13-531003-5 .
