Browsing by Subject "optic neuritis"

Now showing 1 - 2 of 2
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    Should Patients with Optic Neuritis Be Treated with Steroids?
    (Lippincott Williams & Wilkins, 2015) Mackay, Devin D.; Department of Ophthalmology, IU School of Medicine
    Purpose of review: Optic neuritis is the most common cause of optic neuropathy in young adults. High-dose intravenous corticosteroids (IVCS) were established as the standard of treatment for acute optic neuritis via the Optic Neuritis Treatment Trial (ONTT), with its first findings published more than 20 years ago. Subsequent studies have further clarified the role of corticosteroids in the treatment of acute optic neuritis. Recent findings: Recent clinical research has confirmed existing knowledge of the efficacy and limitations of corticosteroids in the treatment of optic neuritis. Recent studies have examined the role of race, route of administration and combination of IVCS with other therapies. Current evidence continues to support high-dose IVCS as the cornerstone of treatment of acute optic neuritis. Summary: High-dose IVCS are effective in hastening visual recovery in acute typical optic neuritis, but do not affect the final visual outcome. In optic neuritis patients, IVCS may delay progression to clinically definite multiple sclerosis (CDMS) at 2 years, but not at 5 or 10 years. It is reasonable to recommend high-dose IVCS for acute optic neuritis patients with significant vision loss, severe pain and/or white matter lesions on brain MRI in whom the potential for benefit outweighs the risks.
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    Unilateral Optic Neuritis and Central Retinal Vasculitis due to Ocular Syphilis
    (Wolters Kluwer, 2020) Khan, Murtaza S.; Kuruppu, Dulanji K.; Popli, Tanav A.; Moorthy, Ramana S.; Mackay, Devin D.; Neurology, School of Medicine
    Purpose: Report a case of concurrent unilateral optic neuritis and central retinal artery occlusion as the presenting signs of syphilis. Methods: A case report of a 22-year-old man with progressive unilateral vision loss. Results: With no known previous history of syphilis, genital lesions, or other extraocular manifestations, the patient presented with pain with eye movements and decreased color vision. His vision dramatically worsened after a course of oral steroids. Examination was remarkable for severe right optic disk edema with a macular cherry-red spot and mild posterior uveitis. Magnetic resonance imaging of the orbits with contrast revealed enhancement and enlargement of the distal right optic nerve. Fluorescein angiography demonstrated delayed filling of the right central retinal artery, suggestive of impending central retinal artery occlusion. Syphilis serologies were positive from the serum, and cerebrospinal fluid Venereal Disease Research Laboratory test was reactive, consistent with neurosyphilis. Oral steroids were discontinued and vision improved with 2 weeks of intravenous penicillin. Conclusion: This unusual case highlights one of the possible initial presentations of syphilis: unilateral optic neuritis and central retinal artery vasculitis with mild posterior uveitis. The worsening of vision after administration of oral steroids also highlights a potential complication of oral steroid use in the absence of a known etiology of vision loss. A thorough history and examination may be helpful in identifying risk factors for infectious causes, including syphilis, and should prompt additional evaluation.