Infectious optic neuropathy

Infectious Optic Neuropathies

PURPOSE OF REVIEW

This article reviews common infectious optic neuropathies, focusing on the more common and globally important entities.

RECENT FINDINGS

Novel infections continue to emerge and drift geographically over time; not infrequently, these have important neurologic or ocular features. Malarial retinal findings comprise a relatively specific set of findings and serve as an invaluable aid in the diagnosis of cerebral malaria. Therapy continues to evolve and is best formulated in concert with an infectious disease expert.

SUMMARY

Infectious optic neuropathies are less common than inflammatory or ischemic optic neuropathies; may present with varied, overlapping, and nonspecific clinical appearances; and comprise an important differential consideration demanding specific therapy.

Infectious optic neuropathies: a clinical update

Different forms of optic neuropathy causing visual impairment of varying severity have been reported in association with a wide variety of infectious agents. Proper clinical diagnosis of any of these infectious conditions is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular findings. Diagnosis is confirmed by serologic testing and polymerase chain reaction in selected cases. Treatment of infectious optic neuropathies involves the use of specific anti-infectious drugs and corticosteroids to suppress the associated inflammatory reaction. The visual prognosis is generally good, but persistent severe vision loss with optic atrophy can occur. This review presents optic neuropathies caused by specific viral, bacterial, parasitic, and fungal diseases.

Diagnostic neuroimaging in neuro-ophthalmic disorders

PURPOSE OF REVIEW

Neuroimaging studies are a valuable diagnostic tool in the evaluation of a patient with neuro-ophthalmic disease. This review provides an approach to selecting an appropriate imaging study and interpreting the results.

RECENT FINDINGS

MRI and CT are the imaging studies most commonly employed in neuro-ophthalmology. Each modality has unique strengths that make it particularly suitable in certain clinical situations.

SUMMARY

In the current practice of neuro-ophthalmology, the clinician must be familiar with the uses and limitations of neuroimaging studies so they can be used appropriately to improve diagnostic accuracy.

[Is it optic neuritis? Differential diagnosis]

Optic neuritis is clinically suspected when painful, rapidly progressive central visual loss occurs in a young patient who has a relative afferent pupillary defect. Ophthalmoscopy is normal in the majority of cases but papillitis or optic disc palor can occur. Several other diseases can mimic optic neuritis, such as ophthalmological conditions or other diseases affecting the visual pathways. Their appropriate clinical diagnosis is of paramount importance in order to avoid unnecessary or invasive procedures or treatments.

The optic nerve head in acquired optic neuropathies

Acquired optic neuropathies are a common cause of blindness in adults, and are associated with characteristic morphological changes at the optic nerve head. Accurate and prompt clinical diagnosis, supplemented with imaging where appropriate, is essential to optimize management of the optic neuropathy and to counsel the patient appropriately on its natural history. History taking, optic disc findings, visual field assessment and imaging of the nerve head and surrounding retinal nerve fiber layer are all paramount to achieving the correct diagnosis. This Review highlights the optic nerve head features that are common to the acquired optic neuropathies, and describes the features that can be used to differentiate these various conditions.

[Bartonella henselae as a cause of optical nerve neuritis]

INTRODUCTION

Bartonella henselae is included into the group of gram-negative bacteria that can cause not so rare disease known as cat-scratch disease (CSD). This disease is characterized by the specific general symptoms, and the complications in the eyes can be manifested in the form of neuroretinitis, follicular conjunctivitis and focal chorioretinitis. In this paper clinical and epidemiological characteristics of a patient with ophthalmologic complications caused by Bartonella henselae are described. We indicate diagnostic possibilities and the criteria for making the diagnosis.

CASE REPORT

We presented a 42-year-old female patient with CSD symptoms, and with a registered neuritis as an ophthalmologic complication. Two weeks after the occurrence of a scratch on the hand after the contact with a cat, there was a slight lymphadenopathy of the axial area of the left side, accompanied by light febrility and weakness. A week after these symptoms occuring, the patient complained of a reduction of the visual acuity in her left eye. The established visual acuity in the left eye was 0.1 with ophthalmological findings of a light edema of the optical disk and a partial star-like edema in the nasal half of the macula. Central scotoma was present, with the extension of the blind spot and the constriction of central isopter of the left eye visual field. Fluorescein biomicroscopy revealed an intensive leaking of fluoresceins at the level of optical disk and macular region in an early arterial phase, without the appearance of pathological phenomena at the level of retinal blood vessels. With the application of doxycyline 100 mg two times a day, and systemic application of prednisolone (at the initial doses of 120 mg), after a two-week period, there was a full recovery of the visual acuity, out the optical disk edema, and the presence of light edema in the left eye macula receded. The complete disappearance of the edema in the macula was registered four weeks following the application of the therapy.

CONCLUSION

Cat-scratch disease can be recognized by means of characteristic general symptoms, and it must be considered in persons with ophthalmologic picture of neuroretinitis. In spite of the good prognosis for the general condition of a patient, it is advised to apply antibiotic therapy in the cases where ophthalmologic complications appear. We recommend the application of doxycyline 100 mg two times a day, for a month. When pronounced edema of the optical disk and edema in the macula are present, a systematic application of corticosteroids is necessary.