Optic Neuritis And Autoimmune Disorders

Introduction

Optic neuritis is an acute inflammatory demyelinating disorder of the optic nerve.¹ The optic nerve is crucial in sending information to the brain about what we are seeing. Optic neuritis is caused by the immune system becoming ‘misprogrammed’, resulting in immune cells attacking the healthy myelin that covers the optic nerve.

Optic neuritis is often associated with various autoimmune disorders. Autoimmune disorders are conditions arising from an abnormal immune response to a functioning body part. 

Causes 

It is thought that there are multiple causes of optic neuritis, including: 

• Autoimmunity (caused by antibodies and lymphocytes)
• Infection 
• Demyelination 
• Granulomatous disease
• Paraneoplastic disorders 

Sometimes, optic neuritis seemingly occurs with no prior warning or ‘trigger’ event.²

Symptoms

Optic neuritis can cause issues with one or both eyes. The symptoms vary between each patient; they include:²

• Blurred vision
• Pain when moving the eye
• Loss of colour vision, or even complete loss of vision 

Diagnosis

Diagnosis involves an eye specialist examining the eye and conducting specific eye tests. It is also common for scans, MRI, optical coherence tomography (OCT), and cerebrospinal fluid (CSF) examinations to be done.³

Treatment

In order to reduce the inflammation around the optic nerves, steroids will be given. These steroids can be given either orally or directly into the vein via infusion. The steroids will shorten the duration of symptoms; however, they do not improve the long-term outcome of optic neuritis.³

Link between optic neuritis and autoimmune disorders

Multiple sclerosis 

Multiple sclerosis (MS) is a demyelinating autoimmune condition that affects the central nervous system, causing a wide range of symptoms, including problems with vision, arm and leg movement, sensation and balance.  MS is one of the autoimmune disorders commonly associated with optic neuritis. Optic neuritis is considered an initial attack of MS. Approximately 20% of those with MS initially present with optic neuritis, and around 50% of MS patients have optic neuritis that occurs during the progression of the disease.¹

Neuromyelitis optica spectrum disorder (NMOSD)

Neuromyelitis optica spectrum disorder (NMOSD) is another autoimmune disorder typically associated with optic neuritis. NMOSD is a demyelinating disease associated with recurrent episodes of optic neuritis and transverse myelitis, often resulting in permanent blindness and/or paralysis.⁴

Other autoimmune disorders associated with optic neuritis

Optic neuritis is not only associated with MS and NMOSD but can occur with many other autoimmune disorders. Two other autoimmune diseases that optic neuritis has been strongly linked to are lupus and Sjögren's syndrome.⁵

Prevention of optic neuritis in autoimmune disorders

Although there is no cure for autoimmune disorders, symptoms can be managed, and early intervention is crucial for the treatment and recovery of optic neuritis and any underlying autoimmune disorder. Any ocular pain or change in vision should be assessed by a medical professional as soon as possible to identify an autoimmune disease such as optic neuritis and treat the symptoms to slow down the progression of any such disease. Eye health should be taken seriously, and regular appointments with an ophthalmologist should be made to identify early signs of disease. 

Lifestyle changes will have to be implemented to manage an autoimmune disorder, but with the right treatment and support, the individual can live a long, healthy life. Exercise, eating healthily, not smoking and taking care of your health to prevent illnesses such as the flu have been shown to be beneficial in the management of autoimmune conditions such as MS.  

Lack of vitamin D has also been identified as a risk factor for autoimmune disease, so adequate intake of vitamin D may help prevent autoimmune disease.⁶ 

Regular follow-up appointments with a healthcare provider are important in the management of any autoimmune condition to ensure any treatment plan that is implemented is working for the individual.

Summary

Optic neuritis is an acute inflammatory demyelinating disorder of the optic nerve associated with autoimmune disorders including, but not limited to, multiple sclerosis, neuromyelitis optica spectrum disorder, lupus and Sjögren's syndrome. Optic neuritis is often an early sign of an autoimmune disease, so any changes in vision or ocular pain should be checked out by a medical professional as soon as possible. There is no cure for autoimmune disorders, but the symptoms of the disorder can be managed to help the individual live a long and healthy life.