Abstract
Optic neuritis is one of the commonest conditions presenting acutely to both Ophthalmic and Neurological services worldwide. In the past 20 years understanding of the management of optic neuritis has departed from an emphasis on those cases associated with multiple sclerosis (emanating from Europe and North America) where there remains no treatment that influences the outcome. We now recognise four additional categories phenotypically and serologically: 1) A post-infectious monophasic disorder 2) An autoimmune, episodic relapsing condition associated with neuromyelitis optica (NMO) and the Aquaporin 4 antibody 3) An autoimmune episodic relapsing condition associated with the myelin oligodendrocyte (MOG) antibody which may show features of NMO and 4) A corticosteroid dependent condition requiring long term immune suppression known as chronic relapsing inflammatory optic neuropathy (CRION), some of which cases are found to have the MOG antibody. In this presentation I will discuss the approach from the point of view of a clinician faced with a patient presenting with his/her first ever episode of optic neuritis. How are the decisions to be made regarding diagnosis and treatment to prevent irreversible visual loss in this and any future attacks, where "time is vision"?
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