New vision loss in one or both eyes, especially with pain when you move your eye, should be seen by an eye doctor the same day.

For patients and families

What it is

Optic neuritis is inflammation of the optic nerve. It most often affects adults between about 20 and 50, and women more than men.¹ ⁶ It can happen on its own or be linked to multiple sclerosis (MS) or to less common conditions called NMOSD and MOGAD.³ ⁴

Common symptoms

• Blurred, dim, or “washed-out” vision in one eye, developing over hours to days
• Pain when moving the eye
• Colors looking faded
• A dark or blurry spot in the center of vision

What happens next

Many people recover much of their vision over weeks to months.¹ Your doctor may order an MRI of the brain and orbits and blood tests, because the results help predict the risk of MS and guide treatment.² In the Optic Neuritis Treatment Trial, IV steroids sped recovery but did not change long-term vision.¹ Your care may be shared with a neurologist.

Go to the emergency department if vision loss is severe, affects both eyes, or comes with weakness, numbness, trouble speaking, or a severe headache.

For clinicians

• Typical demyelinating optic neuritis: subacute monocular loss, periocular pain worse with eye movement, dyschromatopsia, RAPD, central or diffuse field loss; disc normal in most (retrobulbar) or mildly swollen.¹ ⁵
• ONTT findings: IV methylprednisolone followed by oral prednisone hastened recovery without changing 1-year visual outcome; oral prednisone alone at standard dose was associated with a higher recurrence rate.¹ The 15-year cumulative probability of MS was 50%, 25% with no baseline brain MRI lesions and 72% with one or more.²
• Red flags for atypical optic neuritis (consider AQP4-IgG and MOG-IgG testing and urgent neuro-ophthalmology/neurology): bilateral or severe loss, marked disc edema with hemorrhages, no pain or very severe pain, poor recovery, recurrence, steroid dependence, or age outside the typical range.³ ⁴ ⁵ International criteria exist for NMOSD³ and MOGAD.⁴
• Differentials: NAION (painless, sectoral disc edema, older, crowded disc), compressive, infiltrative, infectious, and hereditary optic neuropathies (LHON). In patients over 50, consider GCA.
• OCT RNFL/GCL documents the acute swelling and later thinning, useful for follow-up.⁵

References

1. Beck RW, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. N Engl J Med. 1992;326(9):581-588. https://pubmed.ncbi.nlm.nih.gov/1734247/
2. Optic Neuritis Study Group. Multiple sclerosis risk after optic neuritis: final Optic Neuritis Treatment Trial follow-up. Arch Neurol. 2008;65(6):727-732. https://pubmed.ncbi.nlm.nih.gov/18541792/
3. Wingerchuk DM, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85(2):177-189. https://pubmed.ncbi.nlm.nih.gov/26092914/
4. Banwell B, et al. Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: International MOGAD Panel proposed criteria. Lancet Neurol. 2023;22(3):268-282. https://pubmed.ncbi.nlm.nih.gov/36706773/
5. Biousse V, Newman NJ. Diagnosis and clinical features of common optic neuropathies. Lancet Neurol. 2016;15(13):1355-1367.
6. American Academy of Ophthalmology. What Is Optic Neuritis? https://www.aao.org/eye-health/diseases/what-is-optic-neuritis

How to reach us

Hazleton Eye Specialists: phone 570-453-2020, fax 570-453-1020. Addresses for all five offices (Hazleton, Stroudsburg, Nanticoke, Pottsville, and Bangor) are on Find an Eye Doctor.

Sudden vision loss needs same-day care. Call an eye doctor right away. If you also have a new headache, jaw pain when chewing, scalp tenderness, fever, or you are over 50 and feel unwell, go to the emergency department.

Medical disclaimer. This page is for general education. The patient section is not medical advice, and the clinician section is not a clinical practice guideline; neither replaces an examination, clinical judgment, or specialty consultation. If you have sudden vision loss, seek same-day care from an eye doctor or an emergency department. Information is current as of the “last reviewed” date.