Introduction 

Imagine waking up one morning to find that you have lost some vision in one eye or are unable to see colours clearly. Unfortunately, some people do experience this and later develop a condition called infectious papillitis (IP). However, if treated and diagnosed early, symptoms like vision loss can be prevented. This article outlines the bacterial and viral infections that may cause IP, as well as the different treatments, like antimicrobials or antivirals, that your clinician may prescribe depending on what triggered the IP.¹ 

What is infectious papillitis? 

Papilledema is a type of optic neuritis where a part of the eye nerve (the optic disc) becomes inflamed. The optic disc is where the nerve fibres from the eye connect to the brain to help with vision. This is why papillitis causes vision loss (partial or complete),  which can occur rapidly or gradually, depending on the severity of inflammation.¹

Who gets affected?

Papillitis affects females and males equally and can occur at any age. Some people who develop papillitis may also develop multiple sclerosis (MS), an autoimmune disease which affects the brain and spinal cord.

What are the clinical symptoms?

The most common symptom is vision impairment, with about 70% of people experiencing vision loss in one eye. Vision loss can happen very quickly, often within a few hours, or more slowly over time, depending on the case. In some cases, vision can improve with no treatment. 

However, permanent vision loss is also possible, especially if the condition is not treated in time. Individuals may also experience eye pain, reduced colour vision, and some report seeing flashing lights after eye movement.¹

What is the cause of infectious papillitis?

Infectious papillitis can be caused by both bacterial and viral infections. 

The bacterial causes of IP

Lyme disease

Lyme disease is a bacterial infection transmitted to humans by infected ticks. The bacteria, Borrelia, spreads throughout the body, causing a rash and flu-like symptoms such as joint pain and fever. This immune-system response results in inflammation, which, in rare cases, can progress to papillitis.² 

Mycoplasma pneumoniae

Mycoplasma pneumoniae is a bacterium that can cause respiratory tract infections, often mild yet sometimes leading to pneumonia. In one documented case, Mycoplasma pneumoniae infection further developed into optic papillitis.³

Syphilis 

Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. The infection can result in inflammation inside the eye, which directly affects the optic nerve. Damage to the eye occurs in about 3% of cases, with papillitis having been observed in rare instances.⁴

Tuberculosis 

Tuberculosis (TB) is a contagious, bacterial infection caused by the bacterium Mycobacterium tuberculosis. TB can lead to infection of the eye, called ocular TB, and can result in papillitis.⁵

The viral causes of IP

Herpes simplex eye infection

Herpes simplex viral infection can affect different parts of the body, such as the mouth (oral herpes) or the genitals (genital herpes).  The Herpes virus is highly contagious and can spread to other parts of the body. For example, if you have a cold sore and accidentally touch your lip, then rub your eye, you can risk passing the infection to your eye. In rare cases, this infection of the eye could lead to papillitis.¹

Cytomegalovirus

Cytomegalovirus (CMV) can cause a viral infection that is mainly concerning for those with a weakened immune system. CMV  can lead to eye conditions, like papilledema, due to systemic inflammation that damages the tissues in the eye.⁷

Antimicrobial treatments for infectious papillitis

Tuberculosis-related papillitis

A multi-drug therapy (containing isoniazid, rifampicin, ethambutol and pyrazinamide) has been shown to reduce inflammation and improve vision.^6,8 

Syphilitic papillitis

Penicillin is an antimicrobial treatment for syphilis-related papillitis. Penicillin is given through an intravenous (IV) drip every 4 hours for 10 to 14 days. It is advised to take it as soon as possible, as delays in treatment may result in permanent vision loss.⁹

Lyme disease

Drugs like steroids may improve vision, while antimicrobial therapy with doxycycline can help to resolve eye-related symptoms.²

Antiviral treatments for papillitis

Herpes simplex virus (HSV)

Treatment for herpes-related eye infections includes antiviral medicine like aciclovir. This is taken as eye drops, eye ointments, and sometimes tablets. In severe cases, steroid eye drops may be prescribed to reduce the swelling of the optic nerve.¹

Cytomegalovirus (CMV)

CMV-related papillitis can be treated with long-term antiviral medications such as foscarnet and ganciclovir, which are administered through an IV drip. If treated at an early stage, there is a greater chance of vision recovery.⁷

FAQs

What is infectious papillitis?

Papilledema can also be known as optic neuritis, which is a condition where part of the optic nerve, which connects to the back of the eye, becomes inflamed. It causes eye vision loss, which can be either slight or complete vision loss. It can happen over a long period of time or within a few hours, depending on the severity of the case.

What are the symptoms?

The symptoms are eye pain, reduced colour vision and some report seeing flashing lights after eye movement.

Who does it affect?

Papillitis can affect both females and men equally and can happen at any age. Additionally, some people who develop papillitis have a chance of developing a condition called multiple sclerosis, which affects the brain and spinal cord.

What types of infections cause IP?

Infectious papillitis can be caused by bacterial or viral infections, for example, from polio, measles, pneumonia, meningitis, herpes and Lyme disease.

Can vision loss be treated? 

The vision loss varies depending on the individual. Therefore, some people may have partial vision loss while others lose complete vision. In some cases, vision can improve with no treatment. However, permanent vision loss is also possible, especially if the condition is not treated and diagnosed in time.

Summary

IP is the inflammation of the optic nerve, which connects the eyes to the brain, leading to vision impairment (partial or complete). IP affects both men and women and can occur at any age, causing symptoms such as vision loss, eye pain, reduced colour perception, and flashing lights.IP can be brought on by both bacterial and viral infections, such as Lyme disease, tuberculosis, syphilis, herpes, and cytomegalovirus. Therefore, the treatment for IP is dependent on the cause,  which can be diagnosed by a clinician. Early diagnosis and treatment are recommended to increase the chance of full recovery.