What are the causes of optic neuritis

Optic nerve inflammation

Optic nerve inflammation(Neuritis nervi optici): Inflammatory diseases of the optic nerve, either in the eye (Papillitis) or behind the eye (Retrobulbar neuritis) or with involvement of the retina around the papilla (Neuroretinitis). Optic nerve inflammation can occur as part of autoimmune and systemic diseases, infections or poisoning. In 75% of optic nerve inflammation, however, the cause remains unexplained, with the exception of retrobulbar neuritis: in 30% it is an early symptom of multiple sclerosis; it mainly affects women, especially between the ages of 20 and 45. Treatment is high with cortisone, if bacteria or viruses are involved, antibiotics or antivirals are also used.

Leading complaints

  • Pain behind the eye that gets worse when you move the eyes or put pressure on the eyeball, or headache
  • Rapid, mostly one-sided deterioration of vision up to blindness
  • Blind spot in the center of one eye (increasing central scotoma)
  • Significantly impaired color vision, colors are perceived as darker and more matt, contrasts worse (fog).

When to the doctor

On the same day, at

  • above symptoms.

The illness

The optic nerve runs from the retina to the junction of the optic nerve and then as the optic tract to the visual cerebral cortex. Due to its long path and the fact that it has a thinner protective layer in contrast to body nerves, it is easily affected by diseases of the central nervous system. Depending on which part of the optic nerve is inflamed, one speaks of neuroretinitis, papillitis or retrobulbar neuritis.

In addition, the ophthalmologists divide the optic nerve inflammation into typical and atypical Forms a:

To typical shape include the most common inflammation of the optic nerve, namely those associated with multiple sclerosis (MS) and idiopathic (without an apparent cause) inflammation of the optic nerve. Little is known about the exact inflammatory process, but it is based on an immune reaction against the optic nerve tissue. Whether idiopathic or MS-related, the nerve can be damaged so severely that it leads to blindness. Especially with typical optic nerve inflammation, the inflammatory activity often spontaneously decreases after a few weeks and the visual performance improves again.

It is not uncommon for optic nerve inflammation to be the first manifestation of multiple sclerosis (see also prognosis), which is why if the cause is unclear, antibody tests are used to search for signs of the onset of MS.

To the rare ones atypical forms one counts optic nerve inflammation in the context of

Other rare causes of optic nerve inflammation are

  • Medicines such as ethambutol (used to treat tuberculosis) or tamoxifen (used to treat breast cancer)
  • Poisoning with alcohol, nicotine, thallium, lead or quinine
  • Forwarding inflammation in the eye or sinuses such as uveitis or sinusitis.

Diagnostic assurance

Pain when pressure on the eyeball and the visual disturbances reported by the patient give the ophthalmologist an indication of an inflammation of the optic nerve. In addition, the doctor tests eye movement pain and checks visual acuity. When looking at the fundus of the eye, in the case of papillitis, he sees a swollen papilla with a high blood supply, the edge of the papilla is blurred. If it is purely retrobulbar neuritis, however, the papillary findings are inconspicuous: "The patient sees nothing, and neither does the ophthalmologist."

Optic nerve inflammation leads to one in the affected eye Disorder of the pupillary reaction. Usually, both pupils narrow evenly, regardless of which eye light falls on. An optic nerve inflammation causes the narrowing to vary in strength. At the Swinging flashlight test the ophthalmologist tests this reaction by shining the patient in both eyes one after the other in a darkened room. The affected eye reacts weaker and slower than the other.

In retrobulbar neuritis, multiple sclerosis or another central cause is always suspected. Therefore, the ophthalmologist refers the patient to a neurologist. In addition to a basic neurological examination, an MRI and a lumbar puncture are often arranged to examine the cerebral fluid (liquor).

Differential diagnoses

Eye diseases such as uveitis, glaucoma, macular degeneration and retinal artery occlusion cause symptoms (eye pain, visual field loss, loss of vision) similar to those of optic nerve inflammation.


Intravenous and oral cortisone burst therapy (at high doses) will speed up the inflammation but will have no effect on ultimate vision. A spontaneous improvement may occur within 4 weeks, but sometimes the doctor will find a pale papilla as a sign of one Optic nerve loss (Optic atrophy), which is associated with a decrease in visual acuity or impairment of the visual field.

If the optic nerve inflammation is based on a bacterial or viral infection, it is treated with antibiotics or antivirals. For this, the doctor selects active ingredients that overcome the blood-brain barrier (the natural protective barrier between blood and brain) and thus also develop their effect in the brain tissue.


With consistent treatment, visual acuity usually recovers within about 5 weeks after a typical inflammation of the optic nerve. Usually, however, there are small reductions in color or contrast perception. Atypical forms have a slightly poorer prognosis: After having suffered atypical optic nerve inflammation, patients often have to live with greater loss of visual acuity.

Patients with multiple sclerosis have a 50% risk of developing second optic nerve neuritis. In patients without multiple sclerosis, this risk of recurrence is around 25%.

20-25% of patients with typical optic nerve inflammation, however without Evidence of multiple sclerosis, develop multiple sclerosis within the first 5 years after the disease.

Your pharmacy recommends

Complementary medicine

Acupuncture.Acupuncture can have a positive effect on the course of an inflammation of the optic nerve.

Homeopathy. Homeopathy offers constitutional treatment to subside the inflammation.


Dr. rer. nat. Katharina Munk in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 10:35

Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.