History and exam
Key diagnostic factors
common
peri-orbital/retro-ocular pain
Peri-orbital or retro-ocular, exacerbated by eye movements. Intensity varies.
loss of visual acuity with scotoma
Visual acuity loss ranges from minimal to severe and reaches nadir in 1-2 weeks. Described as seeing through cloud, through fog, through a window with rain drops trickling down.
colour desaturation/loss of colour vision
Symptoms often described as colour of objects not as bright as before.
relative afferent papillary defect (RAPD)
Quantified as trace to grade 4+. Diagnosed using the swinging flashlight test. Pathognomonic of anterior visual pathway dysfunction. Present in most cases of ON.
Other diagnostic factors
common
optic disc swelling
Indicates papillitis (involvement of the most distal, intrabulbar portion of the optic nerve).
neurological abnormalities of multiple sclerosis
Varied; present if ON is part of multiple sclerosis.
uncommon
phosphenes
Positive visual phenomena, described as bright interrupted circles.
Uhthoff's phenomenon
Worsening of visual or other neurological symptoms that accompanies an increase in body temperature, e.g., while jogging
Pulfrich's phenomenon
Illusion, altered perception of moving objects.
peri-venous sheathing
Indicates retinal vascular inflammation.
Risk factors
strong
age 30 to 50 years
Typically third and fourth decade.
female sex
white ethnicity
White people are at higher risk than other racial groups.
HLA-DRB1*1501 genotype
The HLA-DRB1*1501 genotype is a risk factor for optic neuritis (ON), and for conversion of ON to clinically definite multiple sclerosis.
weak
risk factors for multiple sclerosis (MS; Epstein-Barr virus [EBV] infection, vitamin D deficiency, and smoking)
Other risk factors for multiple sclerosis, and thus implicitly for optic neuritis, include a (symptomatic) primary EBV infection in later childhood, adolescence, or adulthood, reduced exposure to vitamin D, and smoking.[13][14][15][16] The magnitude of these risk factors is not known but is probably modest for each in isolation. See Multiple sclerosis (History and exam)
childhood in higher latitudes
People who spent early childhood (up to about age 15 years) in a high-latitude area are at higher risk, even if they migrated to areas of lower latitude after 15 years of age.
presence of autoimmune disease
Some studies show an increased incidence of other autoimmune diseases in patients with multiple sclerosis and their first-degree relatives.[17]
exposure to infectious diseases, such as Lyme disease and syphilis
Risk factors for optic neuritis associated with these infectious agents.
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