Retrobulbar neuritis is a condition in which the optic nerve behind the eye inflames; it also can present suddenly or over a short time span. What it does is that it produces vision blur and color reduction as well as pain behind the eye. Some patients report this pain to be a particular issue that grows worse as the eye moves.
Also, in most cases what we see is the inflammation going down with treatment, that said the base cause for the disease really matters. This is why it is very important that the patient gets eye treatments at an eye specialist hospital at the first sign of these symptoms.
What Is Retrobulbar Neuritis?
Retrobulbar neuritis which is a form of optic neuritis has inflammation behind the eye ball in the optic nerve which transits between the rear of the eye and the brain. As the optic nerve is the highway for visual information from the retina to the brain this inflammation disrupts how the eye reports to the brain.
Unlike some eye issues which are apparent on the surface retrobulbar neuritis may not present much when you look into the eye itself which early on may only present with normal looking eyes in the mirror. That may cause confusion for patients which may have vision issues even when the eye appears normal.
Causes of Retrobulbar Neuritis
There isn’t one cause. In association with multiple sclerosis, infections, auto immune inflammation, toxins we see it put forward, also at time it presents with no clear cause at all.
We discuss mostly that it happens in context of:
- Multiple in which we see multiple sclerosis and also other demyelinating diseases.
- Also viral and other infections.
- Autoimmune and inflammatory disorders.
We see that in some patients retrobulbar neuritis is the first indicator that there may be an underlying neurological issue. That is why in certain cases doctors may order an MRI or refer to a neurologist.
Symptoms Patients Notice
In the classic picture we see blurring or loss of color intensity in one eye, a blind spot, and retrobulbar pain which presents with eye movement. Many report that colors appear “dull” or “less vivid” than normal.
Other symptoms may include:
- Retrobulbar pain or pain behind the eye.
- Central vision loss.
- Black spots in the visual field.
- Vision which deteriorates over the space of days to 2 weeks.
In most cases one eye goes first although in some [cases both eyes may have it at the same time.
Vision Impact
The range of vision impact is from mild blur to severe loss in the affected eye. Some do well and fully recover, while others present with lasting issues of color or contrast which persist after the active inflammation subsides. What that loss will be in terms of which is based on the cause and how early in the process that we get treatment.
Recovery usually starts at the 4 to 8 week mark for the majority, although in some it may take much longer. Also play a role in this is whether neuritis is part of a larger neurological issue.
How Retrobulbar Neuritis Is Diagnosed
Diagnosis includes a thorough eye exam, visual function testing, color vision assessment, pupil response testing, and at times MRI of the brain and orbits. Also the doctor may check the visual field for a central blind spot or other field loss.
It is true that the optic nerve may not stand out as inflamed in a routine exam which is why we use imaging and neurological assessment. This helps to differentiate retrobulbar neuritis from other causes of vision loss like retinal disease or pressure related optic nerve problems.
Treatment Options
Treatment is based on the cause of the issue and how bad the vision loss is. In many cases patients see improvement without treatment, but corticosteroids are very much the go to when the loss is large scale or if the doctor is looking at fast recovery.
Treatment may include:
- High-dose corticosteroids to reduce inflammation.
- Treatment of any underlying infection or autoimmune disorder.
- Neurology follow-up if multiple sclerosis or another demyelinating disease is suspected.
- Ongoing observation with repeat vision testing.
Treat the issue at hand, determine the cause, and very closely monitor recovery.
When To Seek Urgent Care
You should have an ophthalmological assessment at the onset of sudden blurred vision, eye pain which gets worse with movement, color dimming, or a dark spot in one eye. These symptoms may be of retrobulbar neuritis or another issue of the optic nerve which should not be ignored.
Also very important is if symptoms are associated with headache, weakness, numbness or other neurologic signs. In that case a team approach of ophthalmic and possibly neurologic evaluation is often required.
Eye Care at Vasan Eye Care
At Vasan Eye Care we evaluate patients with what we think may be retrobulbar neuritis with a detailed eye exam, vision testing, and in some cases imaging to determine the cause and the degree of the condition. We then guide the patient forward which may go into medical treatment, neurological referral, or close out with a watch and wait plan based on the results.
If you are looking for eye care related to vision loss of unknown cause or retrobulbar pain we tell our patients to get into an eye hospital as soon as possible which really makes a difference. We aim to preserve vision, to identify the cause early and also to rule out any more serious underlying health issues.
Key Takeaways
Retrobulbar neuritis which is inflammation of the optic nerve behind the eye also causes blurred vision, color fading, and retrobulbar pain with eye movement.
It may result from multiple sclerosis, infections, autoimmune disease, toxins, or may happen without any known cause.
Treatment generally includes corticosteroids and management of the base cause, with improvement usually seen within weeks.
Early evaluation is important as sometimes optic nerve inflammation is the first sign of a larger neurological issue.
Frequently Asked Questions
It may be serious as the optic nerve is affected, and this in turn may lead to large scale vision loss. While many cases do get better, some present with permanent changes in color, contrast, or visual field which are more likely if the cause is a complex one.
Commonly we see use of corticosteroids for inflammatory issues and at the same time management of the base cause if that is determined. In some cases no treatment is given and instead close follow up and proper evaluation is what is done.
Usually an ophthalmologist will take the lead in eye assessment, a neuro-ophthalmologist or a retina trained ophthalmologist depending on the case. Also a neurologist may get involved if there is a case of multiple sclerosis or other neurological issues.
Vision loss tends to progress for about 2 weeks and then start to stabilize or improve. The time for full recovery very much varies and some patients may still have some residual visual issues even after the acute inflammation has settled.
Reference Links
- Harvard Health – Retrobulbar Neuritis
https://www.health.harvard.edu/diseases-and-conditions/retrobulbar-neuritis-a-to-z - StatPearls / NCBI – Optic Neuritis
https://www.ncbi.nlm.nih.gov/books/NBK557853/