Neuro-Ophthalmic
Optic Neuritis
Also known as: optic neuritis, retrobulbar neuritis, optic nerve inflammation, painful vision loss, MS eye, multiple sclerosis visual, RAPD reduced colour, Uhthoff phenomenon
Filed as: Urgent
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Inflammatory demyelinating optic neuropathy, typically presenting in a younger adult with subacute monocular vision loss that worsens over days before recovering over weeks. Pain on eye movement, reduced colour saturation and a relative afferent pupillary defect are the characteristic features, often with a central or centrocaecal scotoma. Urgent neuro-ophthalmology referral is indicated, since compressive lesions can mimic the presentation and imaging guides both the assessment and the demyelination risk discussion.
Recognition
Symptoms: what patients report
- Subacute painless or painful loss of vision in one eye — vision loss typically worsens over days, then recovers over weeks.
- Pain on eye movement — a classic early feature, present in 90% of cases.
- Reduced colour saturation (dyschromatopsia) — often the first and most persistent defect.
- Central or centrocaecal scotoma.
- Uhthoff phenomenon — transient worsening of vision with exercise or heat.
- Prior episodes of demyelination (limb weakness, sensory disturbance, ataxia) suggest known or possible MS.
Signs: what the examination shows
- Reduced visual acuity — variable from mild blur to bare light perception.
- Relative afferent pupillary defect (RAPD) — present in unilateral or asymmetric bilateral disease.
- Colour vision reduced — Ishihara plates or colour comparison between eyes.
- Central visual field defect — Humphrey or Amsler.
- Disc appearance: swollen (papillitis) in one third; normal (retrobulbar neuritis) in two thirds.
- No cells, flare, or other anterior segment inflammation.
What OptoGuide™ covers for optic neuritis
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Demyelinating Optic Neuritis — EyeWiki
- The Neuro-Ophthalmology Survival Guide (Pane, Miller & Burdon) — standard reference text
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.