Differential diagnosis

Papilledema: Initially there is no loss of function.

Ischemic optic neuropathy: The central scotoma is lacking, and patients are usually over the age of 60.

Treatment: This depends on the underlying disorder. Retrobulbar optic neuritis with severe loss of vision (less than 0.1) may be treated with high doses of steroids, i.e., 1000 mg of oral prednisolone daily for three days and 1 mg of oral prednisolone per kilogram of body weight on days four through fourteen. However, this treatment only leads to more rapid restoration of vision. Final visual acuity after one year is identical with or without high-dose steroid therapy.

Prognosis: This depends on the underlying disorder. Severe permanent losses of visual acuity are possible, as are significant spontaneous improvements. Retrobulbar optic neuritis in diffuse encephalitis usually exhibits a strong tendency toward spontaneous improvement within four weeks without any treatment. However, discrete functional defects such as reduced visual contrast and reduced perception of color intensity will always remain. Morphologic findings always include a pale optic disk as a result of complex atrophy of the optic nerve following papillitis or partial isolated atrophy of the optic nerve following retrobulbar optic neuritis.

Fig. 13.11 a Papillitis in Lyme disease: The margin of the optic disk is slightly obscured by edema and hy-peremia of the head of the optic nerve. The optic cup is obscured.

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