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Neurology (Expert Forum)
Episcleritis, Scleritis, Optic Neuritis Problems
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury
Episcleritis, Scleritis, Optic Neuritis Problems
by bob mues, Jul 18, 2005 12:00AM
49 yr old male, good health, recently having eye problems. Started w/ redness in left eye, then right 1 wk after trip to Caribbean 6 mo. ago. Wks later started getting severe pain. Diagnosed with epi-scleritis. Prednisone drops didn’t help, pain got worse. Ophthalmologist said I had scleritis. Blood tests for auto-immune causes revealed no problems. After 3 mo. w/redness/pain 2 steroid injections (1 wk apart) were done in right eye Redness/pain went away in right eye, but started getting blurring in right eye days after 2nd injection. MRI revealed neither systematic problem nor MS. Staff optic neurologist said case was rare; concluded severe swelling may have pinched arteries supplying blood to optic nerve, he had nothing to offer. Second opinion confirmed optic neuritis. Was put on IV & prednisone (oral). No improvement in right eye but redness in left went away. VER test confirmed optic neuritis. Retina specialist affirmed diagnosis but indicated dangerous to inject steroids directly in white of eye. Now redness/pain again bothering left eye. Doctors say it’s epi-sceritis; taking prednisone drops (2 weeks), no improvement; also using non-steroid drops (AcularLS) & endomethacin. Consensus is case is idiopathic. Could steroid injections damage optic nerve? Coincidental occurrence of optic neuritis after 2nd injection? Could I have infectious/viral cause? Is it normal to have some discomfort with the optic neuritis after 7 wks? Optic neurologist says swelling gone down. Is it unusual for episcleritis re-appear (left eye) after IV / prednisone treatment?
Doctor's Answer
by CCF-Neuro-M.D.-PW, Jul 21, 2005 12:00AM
There are a variety of causes for optic neuritis, some of which are primarily neurological - such as MS, optic nerve compression by a tumor etc. But these are unlikely to cause episcleritis as well, unless there was some superimposed infection to the sclera.
Other causes include toxins such as methanol, alcohol, tobacco, certain drugs such as chloroquine (for malaria), amiodarone etc
Also, ischemic causes such as anterior ichemic optic neuropathy, usually related to severe anemia or hypotension. Glaucome is another cause - I do not knwo if your ocular pressure was elevated - if it was, and maybe seconarily to an infectious or autoimmune scleritis, then this can cause optic atrophy.
Infectious causes (think of any exposure in the Carribbean to animals, infected water etc) include syphilis, ameobiasis, toxoplasmosis, toxocara, bartonella and other parasitic infections. Autoimmune causes such as ankylosing spondylitis, inflammatory bowel disease and lupus could be tested for.
Its hard for me to be more specific without knowing more details - your doctors need to evaluate the likeliehood of these possibiliteis and test appropraitely. Many cases of optic neuritis remain undiagnosed. Later, if due to demyelinating disease (such as MS) they become apparant when other episodes of demyelination occur.
IV Steroids for autoimmune/demyelinating optic neuritis are benefical if given within 2-4 weeks of onset. oral steroids alone were not effective in the largest trials of MS related optic neuritis. Local steroids for autoimmune causes may be benefical but are outside my area of expertise - without a clear diagnosis first, a benefit is questionable. Repeated steroids may not damage the optic nerve but could cause other problems such as cataracts. If an infectious process is still a possibility they may not be such as good idea. Most of the infections I listed above are apparent by examination. In a discrete episode of optic neuritis, it resolves or reaches maximum improvement at 4-8 weeks. If episcleritis reappears after successful treatment, the search for an autoimmune or infectious cause may need to be reevaluated.
Good luck
Other causes include toxins such as methanol, alcohol, tobacco, certain drugs such as chloroquine (for malaria), amiodarone etc
Also, ischemic causes such as anterior ichemic optic neuropathy, usually related to severe anemia or hypotension. Glaucome is another cause - I do not knwo if your ocular pressure was elevated - if it was, and maybe seconarily to an infectious or autoimmune scleritis, then this can cause optic atrophy.
Infectious causes (think of any exposure in the Carribbean to animals, infected water etc) include syphilis, ameobiasis, toxoplasmosis, toxocara, bartonella and other parasitic infections. Autoimmune causes such as ankylosing spondylitis, inflammatory bowel disease and lupus could be tested for.
Its hard for me to be more specific without knowing more details - your doctors need to evaluate the likeliehood of these possibiliteis and test appropraitely. Many cases of optic neuritis remain undiagnosed. Later, if due to demyelinating disease (such as MS) they become apparant when other episodes of demyelination occur.
IV Steroids for autoimmune/demyelinating optic neuritis are benefical if given within 2-4 weeks of onset. oral steroids alone were not effective in the largest trials of MS related optic neuritis. Local steroids for autoimmune causes may be benefical but are outside my area of expertise - without a clear diagnosis first, a benefit is questionable. Repeated steroids may not damage the optic nerve but could cause other problems such as cataracts. If an infectious process is still a possibility they may not be such as good idea. Most of the infections I listed above are apparent by examination. In a discrete episode of optic neuritis, it resolves or reaches maximum improvement at 4-8 weeks. If episcleritis reappears after successful treatment, the search for an autoimmune or infectious cause may need to be reevaluated.
Good luck
Member Comments (2)
by mini-me, Jul 29, 2005 12:00AM
I have been diagnosed with cevical dystonia. My son also has painfull eye muscle spasms . Both eyes roll upward and he cannot control or bring them back down. He says light or/and sunlight aggravates this condition. IS their a medical diagnose for this particular condition? Is it possibly related to dystonia? Thanks for listening.....Mini me
