eye disorders
Optic Neuritis
Diagnosis of Optic Neuritis
Clinical evaluation Magnetic resonance imaging (MRI) Optic neuritis is suspected in patients with characteristic pain and vision loss, particularly if they are young. Neuroimaging, preferably with gadolinium-enhanced MRI of the brain and orbits, is usually done and may show an enlarged, enhancing optic nerve. MRI may also help diagnose multiple sclerosis, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and neuromyelitis optica (NMO). There is usually more extensive enhancement of the optic nerve(s) in NMO and MOGAD. Fluid attenuating inversion recovery (FLAIR) MRI sequences may show typical demyelinating lesions in a periventricular location if optic neuritis is related to multiple sclerosis. Spinal cord involvement can be seen in any of the demyelinating diseases but is usually more extensive in NMO and MOGAD. NMO and MOG antibodies in the serum should be checked for any atypical or severe optic neuritis. Do gadolinium-enhanced MRI for young patients who have eye pain with movement and loss of vision (eg, decreased visual acuity or color vision, field defects) or an afferent pupillary defect. Do spinal cord imaging in patients with neurologic symptoms suggestive of spinal cord involvement, which can be seen in multiple sclerosis, NMO, or MOGAD. 