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Retrobulbar Neuritis


Presentation

  • A 13-year-old boy presented with bilateral retrobulbar neuritis. Three months later he presented with unilateral proptosis and cervical lymphadenopathy. Lymph node biopsy confirmed non-Hodgkin's lymphoma, B-cell type.[ncbi.nlm.nih.gov]
Cervical Lymphadenopathy
  • Three months later he presented with unilateral proptosis and cervical lymphadenopathy. Lymph node biopsy confirmed non-Hodgkin's lymphoma, B-cell type.[ncbi.nlm.nih.gov]
Sputum
  • Sputum test results were negative for acid-fast bacilli. The patient was started on antitubercular (ATT) drugs-isoniazid 300 mg/day, rifampicin 600 mg/day, pyrazinamide 1500 mg/day and ethambutol 1200 mg/day with vitamin B6 20 mg/day.[ijcasereportsandimages.com]
Chronic Cough
  • One year back, he was diagnosed with tuberculosis of spine (thoracolumbar vertebra) based on a history of chronic cough, weight loss, backache, loss of appetite and results of diagnostic tests such as hemogram showed markedly elevated erythrocyte sedimentation[ijcasereportsandimages.com]
Overeating
  • It provides an absolute measurement of local damage in the visual field and has advantages over the recording of perceptual delay and of evoked potentials.[ncbi.nlm.nih.gov]
  • Most cases show some improvement over time, although complete recovery is rare. Optic neuritis usually affects only one eye, but both eyes may be affected.[drugs.com]
  • It is characterized by a sudden loss of vision occurring over a period of from one to eight days. The condition may be acute or chronic, the latter type usually being referred to as toxic amblyopia.[mdedge.com]
  • Optic nerve head drusen are pockets of protein and calcium salts that build up in the optic nerve over time Contact your health care provider if you are having vision problems.[icdlist.com]
Scotoma
  • It was characterized by decreased visual acuity, mid dilated pupil with sluggish reaction, normal optic disc and central scotoma in Humphrey visual field. Visual acuity improved with systemic Acyclovir and steroids.[ncbi.nlm.nih.gov]
  • A cecocentral scotoma may be present and, if bilateral, is almost diagnostic of toxic amblyopia. Etiologic...[mdedge.com]
Vision Disorder
Unilateral Proptosis
  • Three months later he presented with unilateral proptosis and cervical lymphadenopathy. Lymph node biopsy confirmed non-Hodgkin's lymphoma, B-cell type.[ncbi.nlm.nih.gov]
Flame-shaped Hemorrhage
  • Rarely, it can cause visible retinal manifestations, including hyperemia and swelling of the optic disc, flame-shaped hemorrhages on the optic disc and in the retina, and macular edema.[ijcasereportsandimages.com]

Workup

  • A complete workup including cranial imaging, lumbar puncture, and serologic evaluation in patients presenting with acute neuroretinitis is often necessary because treatments are directed toward the underlying pathogen.[lymeneteurope.org]
  • Evaluation of ON thus requires a brilliant clinical detail, appropriate laboratory workup and imaging.[neurologyindia.com]
  • Further workup may include CSF studies of cell count, glucose, protein, VDRL and electrophoresis evaluating for oligoclonal bands.[webeye.ophth.uiowa.edu]
  • If you see no improvement in your condition despite following these tips and remedies, visit your doctor immediately and avail a further diagnostic workup and treatment if necessary.[stylecraze.com]
  • See Workup for more detail.[emedicine.medscape.com]
Normal Chest X-Ray
  • Cursor on image to zoom/Click text to open image Figure 2: Normal chest X-ray. Discussion Antitubercular drugs produce unwanted side effects, especially when used at high dosages and usually for periods of more than two months [5] [6].[ijcasereportsandimages.com]
Abnormal Visual Evoked Responses
  • In seven of ten eyes with abnormal visual-evoked responses, there was an acute increase in posterior vitreous fluorophotometric readings.[ncbi.nlm.nih.gov]

Treatment

  • Prompt treatment with systemic antiviral and steroid improve the visual outcome.[ncbi.nlm.nih.gov]
  • History also revealed that she had taken anti-tubercular treatment for 6 months for tubercular osteomyelitis in the left knee joint at 10 years of age and was fully cured after complete treatment.[jcor.in]
  • The Optic Neuritis Treatment Trial (ONTT) supports the administration of intravenous methylprednisolone sodium succinate (Solumedrol, 250 mg. every 6 hours) for three days.[decisionmakerplus.net]

Prognosis

  • Prognosis The outlook depends on the cause. Cases in which there is no obvious cause or in which the cause is multiple sclerosis often improve after two weeks, but the vision may never completely return to normal.[drugs.com]
  • Article Figures/Media Metrics This article reviews the diagnosis, pathophysiological features, and prognosis of ischemic optic neuropathy, a relatively common cause of visual loss in older patients, including visual loss after cardiac surgery.[doi.org]
  • Long-term prognosis depends on the underlying cause of the condition. If a viral infection has triggered the episode, it frequently resolves itself with no after effects.[medical-dictionary.thefreedictionary.com]
  • It is usually associated with multiple sclerosis (MS), whereas atypical causes of ON differ in their clinical presentation, management, and prognosis.[jcor.in]
  • (Rank 6) 49,562 21,112 15% Type 1 carries poor prognosis, Type 2 can be treated and vision returned Unknown n/a 2% Demyelinating recurrent optic neuritis and non-demyelinating (CRION) [ edit ] The repetition of an idiopathic optic neuritis is considered[en.wikipedia.org]

Etiology

  • […] of the optic neuritis Identify and exclude any differential diagnosis Determine the monitoring schedule and prescribe a treatment program specific to the etiology Patient History Patients with optic neuritis may present with any of the following abnormal[decisionmakerplus.net]
  • The etiological diagnosis of this optic neuropathy represents a real challenge for the clinician given the multitude of possible causes.[omicsonline.org]
  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Also called retrobulbar neuritis . optic neuritis Ophthalmology Inflammation of optic nerve, which may cause abrupt, albeit temporary, loss of vision of the affected eye Etiology Idiopathic, possibly due to viral infection, autoimmune disease, multiple[medical-dictionary.thefreedictionary.com]

Epidemiology

  • […] novelists, and prose writers Literary studies - plays and playwrights Literary studies - poetry and poets Literary theory and cultural studies Shakespeare studies and criticism Media studies Medicine and health Clinical Medicine Dentistry Public Health and Epidemiology[oxfordreference.com]
  • Introduction Definition an inflammatory demyelinating process affecting the optic nerve Epidemiology incidence most commonly affects women between the ages of 20-40 Etiology multiple sclerosis ethambutol ischemic optic neuropathy ( e.g., diabetes mellitus[medbullets.com]
  • Scandinavia, United Kingdom, Canada), again, following the epidemiology of MS 3.[radiopaedia.org]
  • A strong case can be made for "isolated" optic neuritis being a forme fruste of multiple sclerosis, based on similarities between the two in such epidemiologic factors as gender, age, geographic distributions, cerebrospinal fluid changes, histocompatibility[clinicaltrials.gov]
Sex distribution
Age distribution

Pathophysiology

  • Article Figures/Media Metrics This article reviews the diagnosis, pathophysiological features, and prognosis of ischemic optic neuropathy, a relatively common cause of visual loss in older patients, including visual loss after cardiac surgery.[doi.org]
  • We postulate different pathophysiologic mechanisms of ON in our three patients: compression of optic nerve due to sphenoid mucocele in the first patient; extension of bacterial infection to the optic nerve in the second patient; and invasion of aspergillosis[link.springer.com]
  • […] visual reduction/loss Neuritis- painful vision loss presentation Epidemiology Age 18-40 yr Mean age 30-35 yr Incidence 6.4/ 100,000 Female (66%) Highest in higher latitudes; lower near equator Prevalence 115/100,000 Race Caucasian African americans Pathophysiology[fprmed.com]
  • Optic neuritis: Pathophysiology, clinical features, and diagnosis. . Accessed Aug. 19, 2016. Osborne B, et al. Optic neuritis: Prognosis and treatment. . Accessed Aug. 19, 2016. Optic neuritis.[mayoclinic.org]
  • Pathophysiology The pathology of ADON involves demyelination and axonal loss, probably due to an inflammatory process and a delayed hypersensitivity reaction. Recovery is due to remyelination and compensatory neuronal recruitment.[patient.info]

Prevention

  • Prevention Because the underlying cause of most cases of retrobulbar neuritis is unknown, there is usually no way to prevent it.[drugs.com]
  • Prevention Regular annual eye exams are critical to maintaining healthy vision. Early treatment of vision problems can prevent permanent optic nerve damage (atrophy). Resources Books Leitman, Mark. Manual for Eye Examination and Diagnosis . 5th ed.[medical-dictionary.thefreedictionary.com]
  • How could such complications be prevented: The first step is to identify patients in whom ethambutol is relatively contraindicated.[ijcasereportsandimages.com]
  • With others, there is no treatment, or treatment may only prevent further vision loss. Optic glioma (Medical Encyclopedia) Optic nerve atrophy (Medical Encyclopedia) Optic neuritis (Medical Encyclopedia) [ Read More ][icdlist.com]
  • Biousse reports receiving consulting fees from GenSight Biologics and grant support from Research to Prevent Blindness; and Dr.[doi.org]

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