Published: 2021-12-27

Clinical features, diagnosis, and types of optic neuritis

Hany Abdelmoneim Hanafi, Hanin Abdullah Alghamdi, Samir Sulaiman Bassir, Salman Mubarak Almutairi, Athari Za’al Albalawi, Sara Adnan Aljaber, Abrar Abdullah Alyousif, Khaled Mohammed Almuraydhi, Jumana Hamid Alsamadani, Razan Ahmed Aljadrawi, Fatemah Khawyter Matuk, Maha Fawaz Alsubaie, Yousef Saleh Alghamdi


Establishing a proper diagnosis and identifying the underlying etiology of optic neuritis can be challenging in clinical settings. This is due to the various subtypes and etiologies that were reported for the condition. However, conducting a thorough examination and the laboratory and imaging modalities can significantly enhance the diagnosis. Therefore, it is essential to be adequately aware of the different subtypes of optic neuritis and distinguish between the different clinical features and diagnostic findings of each subtype to conduct a proper diagnosis and enhance management of the affected cases. Optic neuritis is a severe condition that can lead to permanent vision loss. In the present literature review, we have discussed the potential clinical features and diagnostic findings of the different types of optic neuritis. More severe cases of optic neuritis are usually associated with NMOSD and IgG-MOG cases with a worsened prognosis. Painless and chronic vision loss might occur secondary to infections and granulomatous diseases. On the other hand, optic neuritis secondary to multiple sclerosis is usually self-limited. Many of the cases of optic neuritis are characterized by being responsive to steroid therapy. However, acute vision loss was also reported in some cases. Therefore, clinicians must be knowledgeable enough to conduct the most appropriate diagnostic and management modalities to enhance the prognosis of the affected patients. Further research is needed for optimizing the treatment plan and drawing better interventions.


Optic neuritis, Systemic diseases, Diagnosis, Clinical presentation, Optic nerve disease

Full Text:



Martínez-Lapiscina EH, Fraga-Pumar E, Pastor X, et al. Is the incidence of optic neuritis rising? Evidence from an epidemiological study in Barcelona (Spain), 2008-2012. J neurol. 2014;261(4):759-67.

Woung LC, Lin CH, Tsai CY, Tsai MT, Jou JR, Chou P. Optic neuritis among National Health Insurance enrollees in Taiwan, 2000-2004. Neuroepidemiology. 2007;29(3-4):250-54.

Rodriguez M, Siva A, Cross SA, O'Brien PC, Kurland LT. Optic neuritis: a population-based study in Olmsted County, Minnesota. Neurol. 1995;45(2):244-50.

Soelberg K, Jarius S, Skejoe HPB. A population-based prospective study of optic neuritis. Multiple Sclerosis J. 2017;23(14):1893-1901.

Percy AK, Nobrega FT, Kurland LT. Optic neuritis and multiple sclerosis. An epidemiologic study. Archives of ophthalmology (Chicago, Ill : 1960). 1972;87(2):135-9.

Stunkel L, Kung NH, Wilson B, McClelland CM, Van Stavern GP. Incidence and Causes of Overdiagnosis of Optic Neuritis. JAMA ophthalmol. 2018;136(1):76-81.

De Lott LB, Bennett JL, Costello F. The changing landscape of optic neuritis: a narrative review. J neurol. 2021.

Beck RW, Cleary PA, Anderson MM, Jr., et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group. N Eng j med. 1992;326(9):581-8.

The clinical profile of optic neuritis. Experience of the Optic Neuritis Treatment Trial. Optic Neuritis Study Group. Archives of ophthalmology (Chicago, Ill : 1960). 1991;109(12):1673-8.

Multiple sclerosis risk after optic neuritis: final optic neuritis treatment trial follow-up. Arch neurol. 2008;65(6):727-32.

Kupersmith MJ, Mandel G, Anderson S, Meltzer DE, Kardon R. Baseline, one and three month changes in the peripapillary retinal nerve fiber layer in acute optic neuritis: relation to baseline vision and MRI. J neurological sci. 2011;308(1-2):117-23.

Gabilondo I, Martínez-Lapiscina EH, Fraga-Pumar E. Dynamics of retinal injury after acute optic neuritis. Ann neurol. 2015;77(3):517-28.

Kupersmith MJ, Gal RL, Beck RW, Xing D, Miller N. Visual function at baseline and 1 month in acute optic neuritis: predictors of visual outcome. Neurology. 2007;69(6):508-14.

Kupersmith MJ, Alban T, Zeiffer B, Lefton D. Contrast-enhanced MRI in acute optic neuritis: relationship to visual performance. Brain: a j neurol. 2002;125(Pt 4):812-22.

Mealy MA, Whetstone A, Orman G, Izbudak I, Calabresi PA, Levy M. Longitudinally extensive optic neuritis as an MRI biomarker distinguishes neuromyelitis optica from multiple sclerosis. J neurological sci. 2015;355(1-2):59-63.

Ramanathan S, Prelog K, Barnes EH. Radiological differentiation of optic neuritis with myelin oligodendrocyte glycoprotein antibodies, aquaporin-4 antibodies, and multiple sclerosis. Multiple sclerosis (Houndmills, Basingstoke, England). 2016;22(4):470-82.

Thompson AJ, Banwell BL, Barkhof F. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17(2):162-73.

Jurynczyk M, Messina S, Woodhall MR. Clinical presentation and prognosis in MOG-antibody disease: a UK study. Brain: a J neurol. 2017;140(12):3128-38.

Chen JJ, Flanagan EP, Jitprapaikulsan J. Myelin Oligodendrocyte Glycoprotein Antibody-Positive Optic Neuritis: Clinical Characteristics, Radiologic Clues, and Outcome. Am j ophthalmol. 2018;195:8-15.

Hacohen Y, Wong YY, Lechner C. Disease Course and Treatment Responses in Children With Relapsing Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. JAMA neurol. 2018;75(4):478-87.

Wingerchuk DM, Banwell B, Bennett JL. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85(2):177-89.

Kleiter I, Gahlen A, Borisow N. Neuromyelitis optica: Evaluation of 871 attacks and 1,153 treatment courses. Ann neurol. 2016;79(2):206-16.

El-Qushayri AE, Ghozy S, Reda A, Kamel AMA, Abbas AS, Dmytriw AA. The impact of Parkinson's disease on manifestations and outcomes of Covid-19 patients: A systematic review and meta-analysis. Rev Med Virol. 2021:e2278.

Nguyen TM, Huan VT, Reda A. Clinical features and outcomes of neonatal dengue at the Children's Hospital 1, Ho Chi Minh, Vietnam. J clin virol. 2021;138:104758.

Dutton JJ, Burde RM, Klingele TG. Autoimmune retrobulbar optic neuritis. American journal of ophthalmology. 1982;94(1):11-7.

Frohman L, Dellatorre K, Turbin R, Bielory L. Clinical characteristics, diagnostic criteria and therapeutic outcomes in autoimmune optic neuropathy. Bri j ophthalmol. 2009;93(12):1660-6.

Benoilid A, Tilikete C, Collongues N. Relapsing optic neuritis: a multicentre study of 62 patients. Multiple sclerosis (Houndmills, Basingstoke, England). 2014;20(7):848-53.

Son PT, Reda A, Viet DC. Exchange transfusion in the management of critical pertussis in young infants: a case series. Vox Sang. 2021;116(9):976-82.

Thieu H, Bach Dat B, Nam NH. Antibiotic resistance of Helicobacter pylori infection in a children's hospital in Vietnam: prevalence and associated factors. Minerva medica. 2020;111(5):498-501.

El-Qushayri AE, Dahy A, Reda A. A closer look to the high burden of the psychiatric disorders among health care workers (HCWs) in Egypt during COVID-19 outbreak: A meta-analysis of 3137 HCWs. Epidemiol health. 2021:e2021045.

Kidd D, Burton B, Plant GT, Graham EM. Chronic relapsing inflammatory optic neuropathy (CRION). Brain : a j neurol. 2003;126(Pt 2):276-84.

Petzold A, Plant GT. Chronic relapsing inflammatory optic neuropathy: a systematic review of 122 cases reported. J neurol. 2014;261(1):17-26.

Cross SA, Salomao DR, Parisi JE. Paraneoplastic autoimmune optic neuritis with retinitis defined by CRMP-5-IgG. Ann neurol. 2003;54(1):38-50.

Jarius S, Wandinger KP, Borowski K, Stoecker W, Wildemann B. Antibodies to CV2/CRMP5 in neuromyelitis optica-like disease: case report and review of the literature. Clin neurol neurosurg. 2012;114(4):331-5.

Igarashi N, Sawamura H, Kaburaki T, Aihara M. Anti-Collapsing Response-Mediating Protein-5 Antibody-Positive Paraneoplastic Perioptic Neuritis without Typical Neurological Symptoms. Neuro-ophthalmol (Aeolus Press). 2017;41(1):24-9.

Kampylafka EI, Alexopoulos H, Kosmidis ML. Incidence and prevalence of major central nervous system involvement in systemic lupus erythematosus: a 3-year prospective study of 370 patients. PloS one. 2013;8(2):e55843.

Lin YC, Wang AG, Yen MY. Systemic lupus erythematosus-associated optic neuritis: clinical experience and literature review. Acta ophthalmologica. 2009;87(2):204-10.

Asgari N, Jarius S, Laustrup H. Aquaporin-4-autoimmunity in patients with systemic lupus erythematosus: A predominantly population-based study. Multiple sclerosis (Houndmills, Basingstoke, England). 2018;24(3):331-9.

Jarius S, Jacobi C, De Seze J. Frequency and syndrome specificity of antibodies to aquaporin-4 in neurological patients with rheumatic disorders. Multiple sclerosis (Houndmills, Basingstoke, England). 2011;17(9):1067-73.

Massara A, Bonazza S, Castellino G. Central nervous system involvement in Sjögren's syndrome: unusual, but not unremarkable-clinical, serological characteristics and outcomes in a large cohort of Italian patients. Rheumatology (Oxford, England). 2010;49(8):1540-9.

Abdelhakim A, Rasool N. Neuroretinitis: a review. Current opinion in ophthalmology. 2018;29(6):514-519.

Purvin V, Sundaram S, Kawasaki A. Neuroretinitis: review of the literature and new observations. J neuro-ophthalmol. 2011;31(1):58-68.

Bennett JL. Optic Neuritis. Continuum (Minneapolis, Minn). 2019;25(5):1236-64.

Kahloun R, Abroug N, Ksiaa I. Infectious optic neuropathies: a clinical update. Eye and brain. 2015;7:59-81.

Takazawa T, Ikeda K, Nagaoka T. Wegener granulomatosis-associated optic perineuritis. Orbit (Amsterdam, Netherlands). 2014;33(1):13-6.

Niskopoulou M, Du Toit N. Optic neuritis as a feature of Wegener's granulomatosis. Eye (London, England). 2002;16(3):320-1.

Koczman JJ, Rouleau J, Gaunt M, Kardon RH, Wall M, Lee AG. Neuro-ophthalmic sarcoidosis: the University of Iowa experience. Seminars ophthalmol. 2008;23(3):157-68.

Baughman RP, Weiss KL, Golnik KC. Neuro-ophthalmic sarcoidosis. Eye and brain. 2012;4:13-25.