Acute optic neuropathy: differential diagnoses

• Published in: Revista de neurologiá Vol. 57 Suppl 1; pp. S139 - S147
• Main Author: Buompadre, María Celeste
• Format: Journal Article
• Language: Spanish
• Published: Spain 06-09-2013
• Subjects: Acute Disease; Adrenal Cortex Hormones - therapeutic use; Anti-Infective Agents - therapeutic use; Child; Demyelinating Diseases - complications; Diagnosis, Differential; Diagnostic Techniques, Ophthalmological; Endophthalmitis - complications; Endophthalmitis - drug therapy; Humans; Immunoglobulins, Intravenous - therapeutic use; Immunologic Factors - therapeutic use; Intracranial Hypertension - complications; Neuroimaging; Optic Atrophy, Hereditary, Leber - diagnosis; Optic Atrophy, Hereditary, Leber - genetics; Optic Nerve - blood supply; Optic Nerve Diseases - diagnosis; Optic Nerve Diseases - drug therapy; Optic Nerve Diseases - etiology; Optic Neuritis - diagnosis; Optic Neuritis - drug therapy; Optic Neuritis - etiology; Optic Neuropathy, Ischemic - diagnosis; Papilledema - etiology; Prognosis; Pseudotumor Cerebri - complications; Retinitis - diagnosis; Visual Acuity
• ISSN: 1576-6578
• DOI: 10.33588/rn.57S01.2013238

Functional impairment of the optic nerve is characterized by visual loss, dyschromatopsia, visual field defects, relative afferent pupillary defect, and swelling or atrophy of the optic nerve.
To describe the spectrum of acute optic neuropathies, focusing on clinical features, diagnosis and treatment with an emphasis on pediatric entities.
Optic neuritis may be monophasic, recurrent, or part of a polysymptomatic demyelinating process. The aim of the treatment is to reduce number and severity of attacks and prevent future disability. Infectious neuritis is secondary to different microorganisms (bacteria, virus, fungi, or protozoa). Treatment is related to etiology. Nonarteritic ischemic optic neuropathy or idiopathic optic neuropathy is the most frequent form and is secondary to a disorder of small retinal vessels. Leber hereditary optic neuropathy is an important cause of chronic visual impairment and is characterized by selective involvement of the retinal ganglion cells. Until now, no curative treatment is available. Visual acuity is frequently conserved in papilledema associated with intracranial hypertension. The aim of treatment is to reduce intracranial hypertension and risk factors in case it is secondary.
Acute optic neuropathies are broad group of entities, of different etiologies, and with a variable visual prognosis. Findings of neurological examination, fundoscopy, and neuroimaging guide diagnosis and prompt treatment.