Optic Neuritis: Symptoms and Treatment

Table of Contents
View All
Table of Contents

Optic neuritis is an inflammation of the optic nerve. The optic nerve is the bundle of nerve fibers that connects your eye to your brain. The optic nerve transmits visual information to the brain. The optic nerve is covered by a fatty material called myelin that acts as insulation. Myelin helps electrical impulses travel quickly along the nerve. It is commonly believed that optic neuritis develops when the body's own immune system attacks this tissue. Most cases of optic neuritis occur in women who are between the ages of 18 and 50.

Optic nerve diagram
A.D.A.M.

Symptoms

Optic neuritis often causes vision loss and pain upon moving the eye. This pain is caused by stretching of the inflamed optic nerve covering. Flashes of light may also occur with eye movement. Symptoms tend to worsen when body temperature increases. Vision loss is typically gradual and the amount of vision loss is different among patients. Some patients also experience problems with depth perception.

Causes

Optic neuritis can be caused by many diseases and conditions. Some people develop optic neuritis following an illness such as mumps, measles, or flu. In others, the condition is closely related to multiple sclerosis. Some people who have an episode of optic neuritis develop multiple sclerosis later in life. Some cases of optic neuritis are called idiopathic. This means that you have optic neuritis for an unknown reason or undetermined cause.

Other causes of optic neuritis include the following.

Diagnosis

Your eye doctor may detect signs of optic neuritis during a dilated eye exam. He may see a swollen or elevated optic nerve head. Debris, cells or fluid from your immune system may also be present on the retina. Sometimes, you may notice symptoms before your optic nerve shows signs of swelling, a condition referred to as retrobulbar optic neuritis. Your healthcare provider may also notice a difference in the way your pupils react to light. Also, your visual acuity may be reduced, and you may notice blind spots or dim areas in your field of vision. Color vision may also be affected.

To obtain an accurate diagnosis of optic neuritis, your practitioner will perform a comprehensive eye exam after dilating your eyes, including a color vision test and a visual field test. Your healthcare provider may order an MRI and additional blood tests to confirm the diagnosis. He or she may discover abnormalities during visual field testing, color vision testing, and visual acuity testing that will aid in the diagnosis. 

Treatment

Many patients with optic neuritis improve without treatment. Treatment often depends on how soon the condition is diagnosed after you first notice symptoms. In some cases, treatment includes the use of steroids to help reduce inflammation of the optic nerve. A normal course of steroids is three days of IV steroids followed by a few days of tapering the medication. Some people suffer severe side effects while being treated with steroids. If you develop any sudden severe side effects, contact your healthcare provider immediately. Normal side effects of steroid treatment can include the following:

  • difficulty sleeping 
  • stomach upset or nausea
  • a metallic or bitter taste in the mouth
  • anxiety or irritability 
  • increased glucose levels (particularly in diabetics) 
  • thrush (a fungal infection) 

After an episode of optic neuritis, your vision may return to normal or close to normal within six months.

A Word From Verywell

Optic neuritis sometimes recurs and requires retreatment. A small group of people has continued recurrence of the disease and requires ongoing treatment. Over time, about 50 percent of patients with optic neuritis will develop other neurological symptoms that may suggest the diagnosis of multiple sclerosis. Patients with more severe optic neuritis may have a condition called neuromyelitis optica. This condition requires diagnosis with a blood test.

16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Wilhelm H, Schabet M. The diagnosis and treatment of optic neuritisDeutsches Ärzteblatt international. 2015;112(37):616-625. doi:10.3238/arztebl.2015.0616

  2. Johns Hopkins Medicine. Optic neuritis.

  3. Braithwaite T, Wiegerinck N, Petzold A, Denniston A. Vision loss from atypical optic neuritis: patient and physician perspectivesOphthalmol Ther. 2020;9(2):215-220. doi:10.1007/s40123-020-00247-9

  4. Khan B, Nasir S, Hanif S. Bilateral optic neuritis: a rare complication of mumpsCureus. 2020;12(4):e7768. doi:10.7759/cureus.7768

  5. The Optic Neuritis Study Group. Multiple sclerosis risk after optic neuritis: final optic neuritis treatment trial follow-upArch Neurol. 2008;65(6). doi:10.1001/archneur.65.6.727

  6. Medline Plus. Optic neuritis.

  7. Kahloun R, Abroug N, Ksiaa I, et al. Infectious optic neuropathies: a clinical updateEye Brain. 2015;7:59-81. doi:10.2147/EB.S69173

  8. Brigham and Women's Hospital. Visual loss due to temporal arteritis.

  9. Ostroumova OD, Chikh EV, Rebrova EV, Ryazanova AY, Arzhimatova GSh, Moshetova LK. Drug-induced toxic optic neuropathyVestn oftal’mol. 2020;136(4):156. doi:10.17116/oftalma2020136041156

  10. Harvard Health Publishing, Harvard Medical School. Retrobulbar neuritis.

  11. Hoorbakht H, Bagherkashi F. Optic neuritis, its differential diagnosis and managementOpen Ophthalmol J. 2012;6:65-72. doi:10.2174/1874364101206010065

  12. Fields, TR. Steroid side effects: how to reduce corticosteroid side effects. Hospital for Special Surgery.

  13. Bai S, Dormer N, Shoults C, et al. Palatability of a novel oral formulation of prednisone in healthy young adultsJournal of Pharmacy and Pharmacology. 2017;69(4):489-496. doi:10.1111/jphp.12710

  14. CDC. Medications that weaken your immune system and fungal infections.

  15. Johns Hopkins Medicine. Optic Neuritis.

  16. Morrow MJ, Wingerchuk D. Neuromyelitis opticaJournal of Neuro-Ophthalmology. 2012;32(2):154-166. doi:10.1097/WNO.0b013e31825662f1

Additional Reading
  • Slamovits, Thomas L. and Ronald Burde. Neuro-ophthalmology, Textbook of Ophthalmology. Volume 6, ISBN 1-56375-099-6. Copyright 1994, Mosby-Year Book Europe Ltd.

By Troy Bedinghaus, OD
Troy L. Bedinghaus, OD, board-certified optometric physician, owns Lakewood Family Eye Care in Florida. He is an active member of the American Optometric Association.