Retrobulbar Optic Neuritis Research Articles

Influence of retrobulbar neuritis and papillitis on echographically measured optic nerve diameter

Retrobulbar (optic) neuritis is inflammation of the optic nerve that may cause a complete or partial loss of vision. This inflammation can affect a part of the nerve within the eyeball (neuropapillitis) or a part of the nerve behind the eyeball (retrobulbar neuritis). The aim of this study was to establish whether there is a correlation between the diameter of a retrobulbar part of the optic nerve and either visual acuity, prominence of the optic disk (papillitis), or nature of the neuritis (papillitis or retrobulbar). We tested 23 patients with retrobulbar neuritis and papillitis. In addition to a complete ophthalmologic examination, the diameter of retrobulbar region of the optic nerve was measured by the B-scan method. Following this, the 30-degree test was carried out. We found an increased thickness of the retrobulbar region in 22 patients and different responses to the 30-degree test, as well as a statistically significant negative correlation between the thickness of retrobulbar part of the optic nerve and visual acuity. The retrobulbar part of the optic nerve is thicker in 94% of the patients with retrobulbar neuritis and in all the patients with papillitis. There is a correlation between the reduction of visual acuity and thickening of a retrobulbar part.

Infliximab and anterior optic neuropathy: case report and review of the literature

Anti-tumor necrosis factor alpha (TNF alpha) agents have been increasingly used to treat patients with Crohn's disease, psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, and persistent uveitis. We describe a 68-year-old man with Crohn's esophagitis who developed a possible bilateral toxic anterior optic neuropathy during infliximab infusion. This is an observational case report, with review of the PubMed literature from 1977 to present. This 68-year-old man with a 2-year history of Crohn's esophagitis developed acute bilateral visual loss during his third infliximab infusion. His clinical features and laboratory tests were characteristic for a bilateral anterior optic neuropathy. Only three cases of possible infliximab-associated anterior optic neuropathy have been reported in the literature to date. It is important to consider the possibility of anterior optic neuropathy, in addition to retrobulbar optic neuritis, in patients who experience sudden-onset visual loss while being treated with infliximab.

PO20-WE-07 Bilateral retrobulbar optic neuritis in a case of Miller-Fisher syndrome

PO20-WE-07 Bilateral retrobulbar optic neuritis in a case of Miller-Fisher syndrome

Retrobulbar optic neuritis after Hepatitis A vaccination in a HIV-infected patient

Retrobulbar optic neuritis after Hepatitis A vaccination in a HIV-infected patient

Bilateral Retrobulbar Neuritis Due to Varicella Zoster Preceding Retinal Necrosis in a Patient with AIDS

Objective: The purpose of this study is to describe a case report of varicella zoster (VZV) infection presenting as bilateral retrobulbar neuritis affecting optic tracts, chiasm, and bilateral optic nerves preceding bilateral progressive outer retinal necrosis in a single patient with AIDS.Methods:The clinical course of a single patient with confirmed VZV infection will be described including presentation, diagnosis, and treatment.Results:The affected patient presented with acute, bilateral vision loss, and headache. The patient’s history was devoid of past, concurrent, or subsequent development of herpes zoster dermatitis. The patient lacked signs of meningeal irritation or infection. Diagnosis of VZV arachnoiditis and retrobulbar optic neuritis were confirmed by radiological and CSF examination and preceded the clinical identification of retinal involvement. Despite early, aggressive treatment with intravenous antiviral and steroids, as well as intravitreal antiviral therapy, complete bilateral visual loss resulted.Conclusion: Varicella zoster continues to present uniquely in patients with acquired immune deficiency syndrome. Absence of retinal involvement doesn’t rule out retrobulbar visual pathways involvement by VZV. The astute clinician should be aware of this presentation and suspect the involvement of varicella zoster in immunocompromised patients presenting with retrobulbar optic neuritis and meningeal involvement with normal fundus exam.

Linezolid-associated optic neuropathy in a patient with ocular sarcoidosis

We describe a case of bilateral linezolid-associated optic neuropathy in a patient with ocular sarcoidosis. A 70-year-old woman with sarcoidosis noted foggy vision in both eyes. Best-corrected visual acuity was 0.5 in the right eye and 0.9 in the left. No abnormality other than slight optic disc hyperemia was visible in either eye. A central scotoma in both eyes and enlargement of the blind spot in the right eye were detected by Goldmann perimetry examination, and magnetic resonance imaging demonstrated an edematous optic nerve in the right eye. Therefore, retrobulbar optic neuritis resulting from sarcoidosis was initially suspected. Sub-Tenon's capsule injection of triamcinolone acetonide along with steroid pulse therapy was given; however, best-corrected visual acuity worsened to 0.06 in the right eye and 0.08 in the left. Pulse therapy was discontinued on day 1, and the possibility of linezolid-associated optic neuropathy was speculated because linezolid had been given for methicillin-resistant Staphylococcus aureus osteomyelitis 2 years before by an orthopedist. After discontinuation of linezolid, best-corrected visual acuity improved to 0.8 in the right eye and 0.9 in the left, and the optic disc hyperemia in both eyes disappeared. Our findings demonstrate that it is important for ophthalmologists as well as physicians and orthopedists to consider the possibility of optic neuropathy caused by long-term use of linezolid.

Retrobulbar optic neuritis associated with infliximab in a patient with Crohn's disease

Background and aim: Infliximab is a chimeric human-murine monoclonal antibody with a high affinity and specificity for tumor necrosis factor α, which is nowadays widely used in Crohn's disease. An exacerbation of demyelinating disease as an adverse effect of this treatment is rare. The aim of this study was to discuss the relationship between infliximab and optic neuritis. Case report: We describe a 55-year old man with Crohn's disease who developed retrobulbar optic neuritis of the left eye after the infusion of infliximab. The outcome was favorable after systemic steroid treatment. Conclusion: Although the relationship between the onset of visual symptoms and the infusion of infliximab may have been coincidental, we believe that this case report underscores the clinical awareness of the possible association, especially in light of the increasing use of this cytokine inhibitor.

Bilateral Retrobulbar Optic Neuritis, Guillain-Barre Syndrome and Asymptomatic Central White Matter Lesions Following Adult Measles Infection

A 28-year-old woman presented with classic signs of measles and subsequently developed bilateral retro-bulbar optic neuritis and Guillain-Barré syndrome. Her radiographic and CSF findings were consistent with acute measles encephalitis. However, encephalopathy, such as behavioral changes and alteration in consciousness, was not presented. Improvements in the clinical, radiographic, and electrophysiological studies were observed during the steroid therapy. The overlap of CNS and PNS involvement as neurological complications of measles infection is very rare.

Síndrome opticomedular como forma de presentación de un astrocitoma difuso

Spinal cord involvement is a rare presentation of grade II astrocytomas. Nevertheless, differentiation from inflammatory demyelinating diseases of the central nervous system can be challenging in some clinical situations. A patient with an optic-spinal syndrome due to a fibrillary astrocytoma is described. A 32 years-old man was admitted to the hospital because of a subacute spinal cord syndrome. Brain MRI showed no abnormalities, and spinal MRI disclosed a cervical cord lesion suggestive of myelitis. Cerebrospinal fluid analysis revealed oligoclonal bands. Clinical improvement was observed after corticosteroid treatment. Three months later, the patient presented with binocular vision loss. A bilateral retrobulbar optic neuritis was suspected, and corticosteroid therapy was administered again. A new MRI with spectroscopy revealed an infiltrative lesion involving the right frontal lobe, optic chiasm, internal capsule, brainstem and cervical spinal cord, which was suggestive of low-grade astrocytoma. Brain biopsy confirmed the diagnosis of diffuse fibrillary astrocytoma. Differential diagnosis between inflammatory and neoplastic lesions of the central nervous system requires close clinical-radiological follow-up. In this clinical situation, treatment response to corticosteroids and presence of oligoclonal bands in the cerebrospinal fluid may be not necessarily indicative of an inflammatory demyelinating process. Brain biopsy is often necessary for a definite diagnosis.

Application des critères de de Seze et al. sur une série de 14 patients ayant présenté un premier événement démyélinisant aigu sévère

Introduction The application of de Seze et al. criteria (2007) to patients presenting a first severe acute demyelinating event helps to distinguish acute disseminated encephalomyelitis (ADEM) from other CNS inflammatory diseases, with 83% sensitivity and 95% specificity. We applied these criteria to 14 patients who presented a first severe acute demyelinating event and whose later clinical course enabled clear identification of the neurological diagnosis. Method/Patients This study concerned 14 patients who presented a first acute demyelinating event. Initially, there were 16 patients but two were excluded because their initial clinical condition (isolated acute retrobulbar optic neuritis in one and acute cervical myelitis in the other) would have excluded them in the princeps article. We identified 11 women (78.6%) and three men (21.4%) with a mean age of 33.7 ± 12.5 years. Follow-up ranged from three months to 11.5 years after the initial episode (average four years). At last follow-up, the diagnosis was ADEM in seven patients (50%) and multiple sclerosis (MS) in seven (50%). Five of seven patients in the MS group had a tumor-like presentation (71.4%), this parameter partly explaining the initial discrepancy in diagnosis. When applied to our series, de Seze criteria for ADEM exhibited 85.7% sensitivity and 71.4% specificity. Conclusion Applying the new criteria, we did not find the same sensitivity, specificity, and positive and negative predictive values as in the original article. The lack of specificity arose from the misclassification of MS patients with a tumor-like presentation (two out of five false negatives). One of the explanations is that the clinical criteria used can be part of atypical forms of MS, in particular in its tumor-like presentation. De Seze et al. criteria can be an invaluable help for the clinician in the diagnosis of a first severe demyelinating event. Considering our results, these criteria should not be applied for patients with a tumor-like form of MS. A prospective study in a larger cohort is needed to confirm or invalidate these preliminary results.

Neuritis óptica retrobulbar reversible por sinupatía esfenoidal: dos casos clínicos

Optic neuritis are clinically demonstrated by a temporary but severe loss of vision and can be caused by a wide variety of diseases. It is unusual for sphenoidal sinusitis to co-exist with acute optic neuritis, so the simultaneous appearance of both diseases would invite aetiological suspicion. We present two cases where the first clinical manifestation of infectious sphenoidal pathology was retrobulbar optic neuritis, which reverted with treatment, medical in one case and surgical in the other, of the sinusitis.

Retrobulbar Optic Neuritis and Meningoencephalitis Following Progressive Outer Retinal Necrosis due to CMV in a Patient with AIDS

We report on a 34-year-old male patient with AIDS who developed retrobulbar optic neuritis and meningoencephalitis following bilateral progressive outer retinal necrosis (PORN) caused by cytomegalovirus (CMV). This case documents the presumed association of PORN with retrobulbar optic neuritis, and CMV meningoencephalitis in an AIDS patient.

Reversible Retrobulbar Optic Neuritis Due to Sphenoidal Sinus Disorders: Two Case Studies

Optic neuritis are clinically demonstrated by a temporary but severe loss of vision and can be caused by a wide variety of diseases. It is unusual for sphenoidal sinusitis to co-exist with acute optic neuritis, so the simultaneous appearance of both diseases would invite aetiological suspicion. We present two cases where the first clinical manifestation of infectious sphenoidal pathology was retrobulbar optic neuritis, which reverted with treatment, medical in one case and surgical in the other, of the sinusitis.

Thieme Atlas of Anatomy: Head and Neuroanatomy

Establishing a causal relationship between optic neuritis and Lyme disease (LD) has been hampered by technical limitations in serologic diagnosis of LD. Even so, there is a general impression that optic neuritis is a common manifestation of LD. Retrospective case analysis of Lyme serology in 440 patients with optic neuritis examined between 1993 and 2003 in a single neuro-ophthalmic practice at Stony Brook University Medical Center, Suffolk County, New York, a region hyper-endemic for LD. Lyme enzyme-linked immunosorbent assay (ELISA) was positive in 28 (6.4%) patients with optic neuritis, three of whom had syphilis with cross-reactive antibodies. Among the remaining 25 ELISA-positive patients, optic neuritis could be confidently attributed to LD in only one case, a patient with papillitis. The other 24 cases had reactive Lyme serologies related to a history of LD years earlier, asymptomatic exposure, false-positive results, or non-specific humoral expansion. The ELISA in these 24 cases were weakly positive and the Western blots were negative by Centers for Disease Control criteria. There were no significant clinical differences between the 25 seropositive optic neuritis cases and 50 seronegative optic neuritis cases. Based on these cases and a review of the literature, there is insufficient evidence for a causal link between LD and retrobulbar optic neuritis or neuroretinitis. There is sufficient evidence to establish a causal link between LD and papillitis and posterior uveitis.

Neuropathie démyélinisante au cours d’un traitement par anti-TNF alpha et revue de la littérature

Tumor necrosis factor- (TNF) blockers are efficient in the treatment of autoimmune disorders such as inflammatory bowel disease and rheumatoid arthritis, but can induce CNS adverse effects including retrobulbar optic neuritis or aggravation of multiple sclerosis. We report a case of progressive demyelinating polyneuropathy after initiation of Adalimumab (Humira). Corticosteroid and intravenous immunoglobulins were ineffective but the neuropathy improved within six months after adalimunab discontinuation. This case, and other reports recently published suggest that anti-TNF alpha drugs can induce demyelinating neuropathy. Clinicians should be on the lookout for signs evocating neuropathy in patients given anti TNF alpha.

Retrobulbar optic neuritis: a complication of Lyme disease?

Retrobulbar optic neuritis (RON) is an unusual complication of Lyme disease. The diagnosis of early Lyme disease is difficult, and the relationship between RON and Lyme disease remains controversial. None...

Infliximab-induced retrobulbar optic neuritis

A 51-year-old woman underwent four cycles of intravenous infliximab for refractory active ulcerative colitis diagnosed 15 years earlier. She had a 1-month history of fever, abdominal pain and bloody diarrhoea, findings consistent with a relapse of her disease. She was also taking oral mesalazine, prednisone and azathioprine. Three weeks later, during the last cycle of infliximab, she developed pain, blurred vision and a loss in the visual field of the right eye. The results of a neurological examination were unremarkable. Laboratory evaluation revealed a white-cell count of 17 200/mm 3 , and initial ocular examination revealed visual acuities of 20/60 in the right eye and 20/20 in the left eye. Fundus fluorescein angiography was normal; findings from automated perimetry were normal in the left eye but showed an ‘arcuate’ scotoma in the right eye (A). Gadolinium-enhanced T1-weighted coronal magnetic resonance imaging of the brain and orbits (B) revealed enhancement of the orbital portion of her right optic nerve (arrow), findings compatible with retrobulbar optic neuritis. There were no other lesions consistent with demyelination within the brain. Retrobulbar optic neuritis associated with infusion of infliximab is rare, but has occasionally been reported in recent years (Arch Ophthalmol 2002; 120:985–7; Ann Intern Med 2004; 140:W34). Within four weeks of treatment with initial intravenous methylprednisolone, followed by a tapering dose of oral prednisone, the symptoms resolved (visual acuity was 20/20).

Human herpesvirus 6‐associated retrobulbar optic neuritis in an HIV‐infected patient: response to anti‐herpesvirus therapy and long‐term outcome

Like other herpesviruses, human herpesvirus 6 (HHV-6) can reactivate in immunocompromised patients. A case is described of an HIV-1-infected patient who developed bilateral retrobulbar optic neuritis associated with HHV-6 infection. A 59-year-old woman, infected with HIV for 18 years, interrupted antiretroviral treatment because of therapeutic failure and severe metabolic complications. She presented subsequently with blurred vision and ophthalmological examination showed visual loss due to optic neuritis. Her CD4+ count was 285 cells/mm(3) and her plasma HIV-1 RNA level was 5.5 log(10) copies (cp)/ml. Magnetic resonance imaging of the brain was normal. HHV-6 loads were 3.2 log cp/ml in cerebrospinal fluid (CSF) and 6.3 log cp/10(6) peripheral blood mononuclear cells. Combined intravenous treatment was started with foscarnet and ganciclovir then changed to cidofovir and long-term valganciclovir. Her ocular condition improved gradually despite little decrease of the HHV-6 load in the CSF. Salvage antiretroviral treatment was then administered, with marked immunological and virological responses, contributing to further progressive ocular improvement. HHV-6-related optic neuritis has not been described previously in HIV-infected patients. Anti-HHV-6 treatment improved the patient's vision, but immune restoration seems to remain essential for long-term recovery.

Nerve Fibre Layer Analysis with GDx with a Variable Corneal Compensator in Patients with Multiple Sclerosis

Purpose: To evaluate the ability of GDx with variable corneal compensator (VCC) compared to visual-evoked potentials (VEPs) and standard automated perimetry (SAP) in the detection of early optic nerve damage in patients with multiple sclerosis (MS). Methods: 46 eyes of 23 MS patients were included. Ten of them had a history of acute retrobulbar optic neuritis. A control group of 20 normal subjects was also included. All subjects underwent a complete ophthalmological examination and testing with SAP, GDx VCC and VEPs. Results: 19 eyes (41.3%) were abnormal with GDx VCC compared to 38 eyes (82.6%) with SAP and 31 (64.4%) with VEPs. In the optic neuritis group, 9 eyes (69.2%) had optic nerve pallor; SAP was abnormal in 8 of these eyes (61.5%) while VEPs and GDx VCC were abnormal in 6 eyes (46.1%). 2/20 eyes (10.0%) in the control group gave a false-positive abnormal result with SAP. GDx VCC and VEP were normal for all the eyes in the control group. Conclusions: GDx VCC is less able to detect early defects in MS patients compared to the currently used standard techniques of SAP and VEPs.

Neuritis óptica desmielinizante tras tratamiento con Infliximab

We report the case of a 76-year-old woman who attended our hospital because of a sudden loss of visual acuity in her left eye. The problem appeared to be that of retrobulbar optic neuritis. However, the age of the patient together with the simultaneous use of Infliximab to treat her rheumatoid arthritis, suggests the demyelination may have been associated with the Infliximab use. TNFa inhibitors (including Infliximab) are associated with demyelinating diseases including optic neuritis.