Optic Neuritis: An Update Typical and Atypical Optic Neuritis

Optic neuritis (ON) is an acute inflammatory disorder affecting the optic nerve. In those parts of the world where Multiple Sclerosis (MS) is common most cases will have typical demyelinating ON (DON) which will recover spontaneously, but the patients will be at risk of going on to be diagnosed with clinically definite MS after a second episode in another part of the central nervous system. Other patients (perhaps the majority where MS is rare) will have atypical ON, not associated with MS, and will require corticosteroids to induce recovery and often continued immunosuppression to maintain remission. This paper discusses recent advances in knowledge concerning the presentation and treatment of both typical DON and atypical ON, including algorithms to help identify the variety of ON a patient is presenting with and how to treat them acutely.