Papillitis
Overview
A progressive eye disorder characterized by inflammation and degeneration of part of the optic nerve (optic disk) which can result in blindness and can affect only one, or both eyes. The degree of vision loss is variable
Symptoms
* Rapid vision loss within hours or days * Eye movement pain * Permanent vision loss if untreated * Swollen optic disk
Causes
* Optic neuritis * Multiple sclerosis
Diagnosis
Sudden vision loss can signal an ocular emergency. Don’t touch the eye if the patient has perforating or penetrating ocular trauma. If the patient’s vision loss occurred gradually, ask him if the vision loss affects one eye or both and all or only part of the visual field. Is the visual loss transient or persistent? Did the visual loss occur abruptly, or did it develop over hours, days, or weeks? What is the patient’s age? Ask the patient if he has experienced photosensitivity, and ask him about the location, intensity, and duration of any eye pain. You should also obtain an ocular history and a family history of eye problems or systemic diseases that may lead to eye problems, such as hypertension; diabetes mellitus; thyroid, rheumatic, or vascular disease; infections; and cancer. The first step in performing the eye examination is to assess visual acuity, with best available correction in each eye. Carefully inspect both eyes, noting edema, foreign bodies, drainage, or conjunctival or scleral redness. Observe whether lid closure is complete or incomplete, and check for ptosis. Using a flashlight, examine the cornea and iris for scars, irregularities, and foreign bodies. Observe the size, shape, and color of the pupils, and test the direct and consensual light reflex and the effect of accommodation. Evaluate extraocular muscle function by testing the six cardinal fields of gaze.
Prognosis
Prognosis of Papillitis: vision loss may last for months and can be permanent if untreated
Treatment
* Treat underlying causes (e.g., brain tumor, carotid stenosis, cardiac valvular vegetations, hypotension) * Temporal arteritis: Systemic steroids * Nonarteritic ischemic optic neuropathy: Aspirin * Optic neuritis: Systemic steroids * Glaucoma: Topical antiglaucoma medications; peripheral iridotomy for angle closure * Retinal detachment: Surgical repair * Cataracts: Surgical removal * AV fistula: Embolize * Cavernous sinus thrombosis: Antibiotics, anticoagulation * Mucormycosis: Amphotericin B, debridement * Pituitary apoplexy: Systemic steroids, neurosurgical intervention * Herpes zoster: Systemic acyclovir * Tolosa-Hunt: Systemic steroid * Keratoconus/corneal hydrops: Cycloplegic, hypertonic (5%) NaCl ointment, corneal transplant