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Treatments and drugs

By Mayo Clinic staff

Optic neuritis usually gets better on its own. In some cases, steroid medications are used to treat optic neuritis, because they help reduce inflammation in the optic nerve. If you receive steroids, your treatment may involve:

  • Intravenous steroids. You'll likely receive steroid therapy by vein (intravenously) for a few days. Intravenous steroid therapy may accelerate vision recovery, but it doesn't appear to affect the ultimate extent to which you'll recover your vision.
  • Oral steroids. After intravenous steroid therapy, you may take an oral steroid called prednisone for about two weeks. Oral steroids usually follow an intravenous course of steroids, because using oral steroids alone to treat optic neuritis has been associated with an increased risk of recurrence.

In instances in which steroid therapy has failed and severe vision loss persists, a treatment called plasma exchange therapy may help some people recover their vision.

Preventing multiple sclerosis
If you have optic neuritis and you're at high risk of developing multiple sclerosis, you may benefit from drugs that help prevent multiple sclerosis. These drugs include interferon beta-1a (Avonex, Rebif) and interferon beta-1b (Betaseron). These injectable drugs are used to prevent or delay the development of multiple sclerosis in people with optic neuritis who have two or more brain lesions evident on MRI scans.

Prognosis
The prognosis following optic neuritis is generally good. Most people regain close to normal vision within six months after an episode of optic neuritis.

People with multiple sclerosis or neuromyelitis optica may experience recurrent attacks of optic neuritis sometime after they've recovered from the initial episode. Other people without any underlying conditions also may have recurrent optic neuritis. These people have a better prognosis for their vision in the long term than do people with neuromyelitis optica.

References
  1. Germann CA, et al. Ophthalmic diagnoses in the ED: Optic neuritis. American Journal of Emergency Medicine. 2007;25:834.
  2. Asturias EJ, et al. Postinfectious and vaccine-related encephalitis. In: Cohen J, et al. Cohen & Powderly: Infectious Diseases. 2nd ed. St. Louis, Mo.: Mosby; 2004:307.
  3. Degenhardt A. Optic neuritis. In: Ferri FF. Ferri's Clinical Advisor 2009. St. Louis, Mo.: Mosby; 2008:646.
  4. Osborne B. Optic neuritis: Pathophysiology, clinical features, and diagnosis. http://www.uptodate.com/home/index.html. Accessed Jan. 6, 2009.
  5. Osborne B. Optic neuritis: Prognosis and treatment. http://www.uptodate.com/home/index.html. Accessed Jan. 6, 2009.
  6. Multiple sclerosis risk after optic neuritis: Final Optic Neuritis Treatment Trial follow-up. Archives of Neurology. 2008;65:727.
  7. Optic neuritis. The Merck Manuals Online Medical Library: Home Edition for Patients and Caregivers. http://www.merck.com/mmhe/sec20/ch235/ch235c.html. Accessed Jan. 9, 2009.
  8. Weinshenker BG, et al. Neuromyelitis optica IgG predicts relapse following longitudinally extensive transverse myelitis. Annals of Neurology. 2006;59:566.
  9. Polymyalgia rheumatica and giant cell arteritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Polymyalgia/default.asp#poly6. Accessed Jan. 8, 2009.
  10. Olek MJ. Epidemiology, risk factors, and clinical features of multiple sclerosis in adults. http://www.uptodate.com/home/index.html. Accessed Jan. 6, 2009.

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Feb. 13, 2009

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