Patient's question:
Eye pain and pressure, severe vision loss, poor light sensitivity, one week of viral infectionDoctor's answer:
Analysis of the Condition: The optic disc is the intraocular part of the optic nerve. On one hand, it is a continuation of the axons of retinal ganglion cells; on the other hand, it becomes the posterior or intraorbital part of the optic nerve through the scleral foramen. Therefore, inflammation of the optic disc rarely affects the adjacent retina or the posterior optic nerve. However, when the main inflammatory lesions are primarily observed in the optic disc under ophthalmoscopy, it is referred to as optic discitis (apillitis). If there are also significant inflammatory lesions in the retina, it is called optic disc-retinitis (apilla-retiitis). Similar to optic discitis, the former can cause significant visual impairment in the early stages of inflammation, often accompanied by mild vitreous opacity and retroorbital pain.Guidance:
1. Clinical Manifestations: The disease is most common in young and middle-aged individuals, accounting for 86% of cases, and is also seen in children but less frequently in the elderly. Approximately two-thirds of cases involve both eyes, with a rapid onset, often leading to loss of light perception within days. Initially, there may be a dull ache or tightness in the forehead or retrobulbar area, which may diminish with severe visual impairment. In cases of bilateral blindness, the pupils are dilated, and the light reflex is negative. If some vision remains, the pupils remain unchanged, but the light reflex is not sustained (jumping phenomenon). In patients with residual vision, a visual field examination may reveal central scotomas, paracentral scotomas, quadrant defects, or concentric constriction. Using red-green targets, these changes become more pronounced. Visual evoked potential (VEP) values are reduced in electroretinography. Under ophthalmoscopy, the optic disc appears congested, swollen, slightly elevated, and poorly defined. Retinal veins are dilated and tortuous, while arterial diameters are normal, but arterial pulsation can be observed when the globe is slightly compressed. Edema, flame-like hemorrhages, and yellowish-white exudative spots may be present around the optic disc. In some cases, the macula may be affected, leading to radial edema and wrinkling of the macular radial fibers, which may later develop into a star-shaped appearance (at this stage, it is termed optic disc-retinitis). Posterior vitreous, especially in front of the optic disc, often shows dust-like opacities.
2. Etiology: The causes of optic discitis are highly complex and include the following:
1. Local Inflammation:
- Ocular inflammation, such as uveitis, choroiditis, or retinitis, that can spread to the optic disc.
- Viral infections, particularly orbital infections, sinusitis (e.g., maxillary, ethmoid, and sphenoid sinuses), dental caries, or tonsillitis.
2. Systemic Diseases: Tuberculosis, syphilis, demyelinating diseases, and acute infections such as meningitis, influenza, mumps, typhoid, or measles; nutritional and metabolic disorders such as pregnancy, lactation, vitamin deficiencies, anemia, or diabetes.
3. Toxins: Arsenic, lead, or quinine poisoning.
3. Prognosis: The prognosis for optic discitis and optic disc-retinitis is generally poor. However, with timely and appropriate treatment, partial or even complete visual recovery may be achieved. If the condition is not controlled, the optic disc typically shows varying degrees of depigmentation, appearing as poorly defined pale areas, which may eventually lead to secondary optic atrophy.
4. Treatment:
1. Etiological Treatment:
- If the cause is bacterial infection, antibiotics that can cross the blood-brain barrier should be used.
- For syphilis or tuberculosis, specific antimicrobial or antitubercular drugs are required.
- If the cause is dental caries or tonsillitis, the focus should be on eliminating the source of infection.
2. Symptomatic Treatment:
- High-dose corticosteroid pulse therapy may be initiated initially.
3. Supportive Therapy:
- Vitamin B complex supplements may be administered.
5. Nursing Points: Acute patients should rest in bed, stay hydrated, avoid spicy foods, and refrain from alcohol and smoking. Wearing sunglasses when outdoors is recommended. Active treatment of the underlying disease is essential.
Notes: Provide fundus photographs showing typical features of inflammation in the early stage of optic disc-retinitis, the dumbbell-shaped visual field, central scotoma, concentric constriction, and the VEP findings in the inflammatory and atrophic stages.