Retrobulbar Neuritis

[Skatnino]

Hi

I'm struggling to understand what the difference is between Optic Neuritis and Retrobulbar Neuritis. Are the symptoms the same? How is Retrobulbar Neuritis diagnosed? Are the visual outcomes the same? Are there different causes for Retrobulbar Neuritis than for ON? Please let me know. Thanks

[Skatnino]

Thanks again. I've read that some people who present with ON, might actually have AZOOR/AIBSE, will the mfERG prove that? What about MEWDS Multiple Evanescent White Dot Syndrome, could that not be a possibility? What test would reveal that?

Sorry for all the answers, but you are the only one that is actually taking the time to answer them. So, thanks.

[Nancy T]

Did you perhaps mean your last sentence to read "...as the incidence of RECURRENCE is higher"? (Sorry to butt in; I have OCS--obsessive copyeditor syndrome.)

Nancy T.

[John C Hagan III, MD, FACS, FAAO]

recurrent optic neuritis especially if due to MS is very rare to cause complete blindness in one or both eyes. Histo spots cause distorted vision. VEP should show up active ON. The treatment of ON is outlined in the ON Treatment Study and is either NO treatment at all or IV steroids for three days then oral steroids for 7 more days.  Acute ON should not be treated with only oral steroids as the incidence of MS is higher.

JCH III MD

[Skatnino]

Thank you so much for your reply, it helped clear up some of the questions I have. How is vision loss different with acting up histo spots? I'm being scheduled to see a neurologist. If in many cases the recurrent optic neuritis is not diagnosed, have you seen cases where a patient has had recurrent optic neuritis throughout their life without it ever being diagnosed? What test would show retrobulbar neuritis? Would a VEP show that? What is your take on IV Steroids as treatment? Most cases I've read about mention pain, plus heat/exercise related issues, is that something that can develop if I keep having recurrent optic neuritis? I can appreciate it's not easy answering these questions, as most of the answers are based on average cases, but I just have so many unanswered questions, trying to understand what is happening to me. Eventhough I'm afraid to ask, in your opinion, what are the chances of becoming blind in both eyes? Thanks again.

[John C Hagan III, MD, FACS, FAAO]

POHS (presumed ocular histoplasmosis syndrome) would not cause these kind of problem. Neither would low blood pressure, or calcium deficiency.   "Bad circulation" can mean many different things and is not a precise term to use so I cannot comment on it.  A MRI will not pick up small vessel leakage (choroidal neovascularization).

Recurrent optic neuritis is often difficult to diagnose. Many cases the cause is not found this is called "idiopathic". When a cause is found the most common one is multiple sclerosis.

You might consider seeing a neurologist, you may need a spinal tap for fluid analysis.

JCH III MD

[Skatnino]

Thanks for your reply, much appreciated. I'm very confused about my vision issues and not sure if I have Retrobulbar Neuritis (eventhough I was diagnosed by my Opthamoligist). See I went to see her because I was having vision issues that had progessively gotten worse over a few days. She noticed I have Presumed Ocula Histoplasmosis (histo spots) and we did a test at the hospital (they injeced dye through my arm into my eyes and took pictures) from that she ruled out my histo spots creating abnormal blood vessels that were leaking blood. She then said it must be Retrobulbar Neuritis. I had two MRI's done, which were inconclusive. No other side effects, no pain at all, no heat related, exercise related etc. issues. This happened 9 months ago and after about 2 month my vision started clearing up. Then about 5 days ago my vision got bad again (always the right eye), I've got about 3 blind spots and have this fast circling light in my eye occassionally, mostly in the morning and when I get inside from the sun. I'm having a vision field test done on Tuesday and hoping to have a VEP done, which has not been done before.
How do I know it is Retrobulbar Neuritis and not my histo spots leaking? I also have low blood pressure, bad circulation and calcium deficiency. Would a different MRI pick up if I have small blood vessels leaking blood?
Sorry for the long email. I live in Canada and I'm thinking about coming to the US to have tests done.

[John C Hagan III, MD, FACS, FAAO]

Optic neuritis is inflammation of the optic nerve anyplace between inside the eye and where the optic nerve ends in the brain. Retrobulbar neuritis is a for of ON where the inflammation is behind the eye and can't usually be seen when the MD looks in the eye.

Read this excellent reference:

http://www.emedicine.com/Radio/topic488.htm

JCH III MD