Optic neuritis (ON) is a debilitating condition that is defined as inflammation of cranial nerve II which results in disruption of the neurologic pathways that allow visual sensory information received by the

retina The retina (; or retinas) is the innermost, photosensitivity, light-sensitive layer of tissue (biology), tissue of the eye of most vertebrates and some Mollusca, molluscs. The optics of the eye create a focus (optics), focused two-dimensional ...

to be able to be transmitted to the

visual cortex The visual cortex of the brain is the area of the cerebral cortex that processes visual information. It is located in the occipital lobe. Sensory input originating from the eyes travels through the lateral geniculate nucleus in the thalam ...

of the brain. This disorder of the

optic nerve In neuroanatomy, the optic nerve, also known as the second cranial nerve, cranial nerve II, or simply CN II, is a paired cranial nerve that transmits visual system, visual information from the retina to the brain. In humans, the optic nerve i ...

may arise through various pathophysiologic mechanisms, such as through demyelination or

inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...

, leading to partial or total loss of vision. Optic neuritis may be a result of standalone idiopathic disease, but is often a manifestation that occurs secondary to an underlying disease. Signs of ON classically present as sudden-onset visual impairment in one or both eyes that can range in severity from mild visual blurring to complete blindness in the affected eye(s). Although pain is typically considered a hallmark feature of optic neuritis, the absence of pain does not preclude a diagnosis or consideration of ON as some patients may report painlessness. ON is typically subtyped into "typical" ON and "atypical" ON. The most commonly considered etiologies are

multiple sclerosis Multiple sclerosis (MS) is an autoimmune disease resulting in damage to myelinthe insulating covers of nerve cellsin the brain and spinal cord. As a demyelinating disease, MS disrupts the nervous system's ability to Action potential, transmit ...

(MS), neuromyelitis optica (NMO) /

neuromyelitis optica spectrum disorder Neuromyelitis optica spectrum disorders (NMOSD) are a spectrum of autoimmune diseases characterized by acute inflammation of the optic nerve (optic neuritis, ON) and the spinal cord (myelitis).Banerjee S, Butcher R. Rituximab for the Treatment of ...

(NMOSD), and myelin oligodendrocyte glycoprotein-antibody-associated disease (MOGAD). Other etiologies include

idiopathic An idiopathic disease is any disease with an unknown cause or mechanism of apparent spontaneous origin. For some medical conditions, one or more causes are somewhat understood, but in a certain percentage of people with the condition, the cause ...

ON,

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

s (eg,

syphilis Syphilis () is a sexually transmitted infection caused by the bacterium ''Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms depend on the stage it presents: primary, secondary, latent syphilis, latent or tertiary. The prim ...

Lyme disease Lyme disease, also known as Lyme borreliosis, is a tick-borne disease caused by species of ''Borrelia'' bacteria, Disease vector, transmitted by blood-feeding ticks in the genus ''Ixodes''. It is the most common disease spread by ticks in th ...

, and viral infections such as

herpes simplex Herpes simplex, often known simply as herpes, is a viral disease, viral infection caused by the herpes simplex virus. Herpes infections are categorized by the area of the body that is infected. The two major types of herpes are Cold sore, ora ...

and varicella-zoster), and systemic

autoimmune disease An autoimmune disease is a condition that results from an anomalous response of the adaptive immune system, wherein it mistakenly targets and attacks healthy, functioning parts of the body as if they were foreign organisms. It is estimated tha ...

s (eg,

systemic lupus erythematosus Lupus, formally called systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Common ...

and

sarcoidosis Sarcoidosis (; also known as Besnier–Boeck–Schaumann disease) is a disease involving abnormal collections of White blood cell, inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph n ...

). Diagnosis of ON can be made with a combination of symptom manifestation, clinical exam findings, imaging findings, and serologic studies. Modern medical practice employs high-dose

steroid A steroid is an organic compound with four fused compound, fused rings (designated A, B, C, and D) arranged in a specific molecular configuration. Steroids have two principal biological functions: as important components of cell membranes t ...

s, such as IV methylprednisolone, as the first-line treatment for optic neuritis. Optic neuritis should not be confused with

optic neuropathy Optic neuropathy is damage to the optic nerve from any cause. The optic nerve is a bundle of millions of fibers in the retina that sends visual signals to the brain. Damage and death of these nerve cells, or neurons, leads to characteristic featu ...

, which is a condition manifesting as

visual impairment Visual or vision impairment (VI or VIP) is the partial or total inability of visual perception. In the absence of treatment such as corrective eyewear, assistive devices, and medical treatment, visual impairment may cause the individual difficul ...

that occurs as a result of damage to the optic nerve from any cause - one of those causes being optic neuritis.

Classification and causes

Definition

The

comprises

axon An axon (from Greek ἄξων ''áxōn'', axis) or nerve fiber (or nerve fibre: see American and British English spelling differences#-re, -er, spelling differences) is a long, slender cellular extensions, projection of a nerve cell, or neuron, ...

s that emerge from the

of the

eye An eye is a sensory organ that allows an organism to perceive visual information. It detects light and converts it into electro-chemical impulses in neurons (neurones). It is part of an organism's visual system. In higher organisms, the ey ...

and carry visual information to the primary visual nuclei, most of which is relayed to the occipital cortex of the

brain The brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It consists of nervous tissue and is typically located in the head (cephalization), usually near organs for ...

to be processed into vision. The phrase optic neuritis is derived from the pathophysiologic changes observed in this disorder whereby the optic nerve (''optic'') becomes inflamed (''neuritis''). As such, optic neuritis is typically a manifestation of an underlying, causative etiology. Because of the breadth of underlying causes of optic neuritis, this disorder is typically classified into the subtypes of "typical" ON and "atypical" ON. Typical ON refers to a demyelinating etiology which most commonly stems from multiple sclerosis or standalone idiopathic disease. Atypical ON essentially refers to optic neuritis from any other cause.

Typical Optic Neuritis

ON is classified as typical optic neuritis when demyelination is the causative pathophysiologic aberrancy. This classification attributes the manifestation of ON primarily to multiple sclerosis or standalone idiopathic disease, of which multiple sclerosis is the most common underlying etiology of all subtypes of optic neuritis.

Multiple Sclerosis

Multiple sclerosis Multiple sclerosis (MS) is an autoimmune disease resulting in damage to myelinthe insulating covers of nerve cellsin the brain and spinal cord. As a demyelinating disease, MS disrupts the nervous system's ability to Action potential, transmit ...

, in brief, is an autoimmune disease that results in demyelination of the nerves in the

central nervous system The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain, spinal cord and retina. The CNS is so named because the brain integrates the received information and coordinates and influences the activity o ...

(CNS). Demyelination in MS can be diffusely affect the CNS leading to a multitude of physical manifestations. Optic neuritis is acquired this way when MS spreads to the optic nerve. Optic neuritis is often among the first, if not the foremost, manifestation of MS. One review found that inflammatory demyelinating optic neuritic (IDON) is the initial presentation of MS in approximately 20% of studied patients, while another review found that up to 50% of MS patients will develop optic neuritis during their disease course.

Idiopathic Disease

Idiopathic optic neuritis (ION) generally refers to optic neuritis that does not present with serologic markers attributable to a known underlying cause (eg, NMOSD, MOGAD, etc.). Opinions among specialists seem to differ as to whether idiopathic optic neuritis should be classified as MS-associated ON or if it should not be exclusively associated with MS. A group of reviewers from China propose that ION should not be associated with MS and hence defined with the literal meaning of "idiopathic" as ON with an unknown cause. On the other hand, multiple groups of Western reviewers propose that ION should be considered a preceding manifestation, among a collection of manifestations, that precedes the development of MS in the absence of other serologic findings.

Atypical Optic Neuritis

ON is classified as atypical optic neuritis when the underlying cause is an etiology other than multiple sclerosis or standalone idiopathic disease. Atypical ON is most frequently seen as an early manifestation of

(NMOSD), formerly known as neuromyelitis optica (NMO). Other causes of atypical ON include myelin oligodendrocyte glycoprotein-antibody-associated disease (MOGAD), other autoimmune disorders (eg,

Sarcoidosis Sarcoidosis (; also known as Besnier–Boeck–Schaumann disease) is a disease involving abnormal collections of White blood cell, inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph n ...

, Sjogren syndrome,

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...

), and infections (Bacterial nowiki/>Tuberculosis, Syphilis">syphillis, meningitis">Tuberculo.html" ;"title="Tuberculosis.html" ;"title="nowiki/> nowiki/>Tuberculosis, Syphilis">syphillis, meningitis, Lyme disease">Lyme’s disease, Bartonella">Tuberculosis">nowiki/>Tuberculosis, Syphilis">syphillis, meningitis, Lyme disease">Lyme’s disease, Bartonella] or Viral [measles, mumps, rubella, Chickenpox, chicken pox, Herpes simplex virus, herpes]).

NMOSD (Formerly NMO)

Neuromyelitis optica spectrum disorder (NMOSD) is a disorder consisting of six syndromes that cause inflammation and demyelination of the CNS. The hallmark diagnostic criteria of NMOSD is the presence of the aquaporin-4 immunoglobulin G antibodies (AQP4-IgG) found on serology, which is the underlying aberrancy of this autoimmune condition that engenders its distinction from multiple sclerosis. Clinical manifestations of NMOSD, such as optic neuritis, occur due to antibody-mediated damage against the aquaporin-4 transmembrane water channels which are found in the foot processes of

astrocyte Astrocytes (from Ancient Greek , , "star" and , , "cavity", "cell"), also known collectively as astroglia, are characteristic star-shaped glial cells in the brain and spinal cord. They perform many functions, including biochemical control of en ...

s at high concentrations within the optic nerve, brainstem, and spinal cord.

MOGAD

Myelin oligodendrocyte glycoprotein-antibody-associated disease (MOGAD) is an autoimmune condition against the myelin oligodendrocyte glycoprotein (MOG) located on both the myelin sheathe and oligodendrocyte cell surfaces of the CNS. Cell-mediated and complement-mediated inflammation results hallmark findings of perivenous and confluent white matter demyelination.

Infection

A wide range of attributable infectious etiologies have been found to cause optic neuritis and can arise from varying pathophysiologic mechanisms. The underlying inflammation and demyelination has been shown to manifest as anterior optic neuritis, retrobulbar optic neuritis (normal

optic disc The optic disc or optic nerve head is the point of exit for ganglion cell axons leaving the eye. Because there are no rods or cones overlying the optic disc, it corresponds to a small blind spot in each eye. The ganglion cell axons form t ...

), neuroretinitis (optic disc

edema Edema (American English), also spelled oedema (British English), and also known as fluid retention, swelling, dropsy and hydropsy, is the build-up of fluid in the body's tissue (biology), tissue. Most commonly, the legs or arms are affected. S ...

with the macular star), or anterior optic neuropathy. It has been proposed that optic nerve involvement secondary to herpes zoster virus infection can arise from direct nerve inflammation or an

ischemic Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems ...

mechanism leading to inflammatory

thrombosis Thrombosis () is the formation of a Thrombus, blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (a vein or an artery) is injured, the body uses platelets (thrombocytes) and fib ...

. Optic nerve involvement secondary to

cytomegalovirus ''Cytomegalovirus'' (CMV) (from ''cyto-'' 'cell' via Greek - 'container' + 'big, megalo-' + -''virus'' via Latin 'poison') is a genus of viruses in the order '' Herpesvirales'', in the family '' Herpesviridae'', in the subfamily '' Betaherp ...

(CMV) infection has been proposed to involve a similar mechanism in patients with

CMV retinitis Cytomegalovirus retinitis, also known as CMV retinitis, is an inflammation of the retina of the human eye, eye that can lead to blindness. Caused by human cytomegalovirus, it occurs predominantly in people whose immune system has been compromised, ...

. The pathogenesis of ON secondary to HIV has been proposed to arise from autoimmune, vascular, and degenerative ischemic pathways.

Other Causes

Other etiologies associated with optic neuritis include congenital anomalies,

glaucoma Glaucoma is a group of eye diseases that can lead to damage of the optic nerve. The optic nerve transmits visual information from the eye to the brain. Glaucoma may cause vision loss if left untreated. It has been called the "silent thief of ...

, elevated

intracranial pressure Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury ( mmHg) and at rest, is normally 7–15 mmHg for a supine adu ...

(i.e.

papilledema Papilledema or papilloedema is optic disc swelling that is caused by increased intracranial pressure due to any cause. The swelling is usually bilateral and can occur over a period of hours to weeks. Unilateral presentation is extremely rare. In ...

), compression, nutritional and toxic optic neuropathy, trauma, inherited optic neuropathy, or infiltration (eg,

neoplastic A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

granuloma A granuloma is an aggregation of macrophages (along with other cells) that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate. Such sub ...

tous). When an inflammatory recurrent optic neuritis is not demyelinating, it is called chronic relapsing inflammatory optic neuropathy (CRION).

Signs and symptoms

Symptoms

Major symptoms are: * sudden loss of vision (partial or complete), * sudden blurred or "foggy" vision, and *

pain Pain is a distressing feeling often caused by intense or damaging Stimulus (physiology), stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sense, sensory and emotional experience associated with, or res ...

on movement of the affected eye. Patients with optic neuritis may experience

dyschromatopsia Color blindness, color vision deficiency (CVD) or color deficiency is the decreased ability to see color or differences in color. The severity of color blindness ranges from mostly unnoticeable to full absence of color perception. Color bl ...

which describes a range of

color vision Color vision, a feature of visual perception, is an ability to perceive differences between light composed of different frequencies independently of light intensity. Color perception is a part of the larger visual system and is mediated by a co ...

in the affected eye (especially red), with colors appearing subtly washed out compared to the other eye. Patients may also experience difficulties judging movement in depth, which can be particular troublesome during driving or sport ( Pulfrich effect). Likewise, transient worsening of vision with increase of body temperature (

Uhthoff's phenomenon Uhthoff's phenomenon (also known as Uhthoff's syndrome, Uhthoff's sign, and Uhthoff's symptom) is the worsening of neurologic symptoms in multiple sclerosis (MS) and other demyelinating diseases when the body is overheated. This may occur due t ...

) and glare disability are a frequent complaint. Involvement of the optic nerve may be unilateral or bilateral, depending on the underlying etiology. For example, MS-optic neuritis often presents unilaterally while NMOSD-optic neuritis and MOGAD-optic neuritis more often present bilaterally. However not everyone who has optic neuritis has problems with their vision.

Early Symptoms

Early symptoms that require investigation include symptoms from multiple sclerosis (twitching, lack of coordination, slurred speech, frequent episodes of partial vision loss or blurred vision), episodes of "disturbed/blackened" rather than blurry indicate moderate stage and require immediate medical attention to prevent further loss of vision. Other early symptoms are reduced

night vision Night vision is the ability to see in low-light conditions, either naturally with scotopic vision or through a night-vision device. Night vision requires both sufficient spectral range and sufficient intensity range. Humans have poor night v ...

photophobia Photophobia is a medical symptom of abnormal intolerance to visual perception of light. As a medical symptom, photophobia is not a morbid fear or phobia, but an experience of discomfort or pain to the eyes due to light exposure or by presence o ...

and red eyes.

Variation in symptoms with age

Several case studies in children have demonstrated the absence of pain in more than half of cases (approximately 60%) in their pediatric study population, with the most common symptom reported simply as "blurriness". Other remarkable differences between the presentation of adult optic neuritis as compared to pediatric cases include more often unilateral optic neuritis in adults, while children much predominantly present with bilateral involvement.

Diagnostics

The

World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...

ICD-11 The ICD-11 is the eleventh revision of the International Classification of Diseases (ICD). It replaces the ICD-10 as the global standard for recording health information and causes of death. The ICD is developed and annually updated by the World H ...

classification includes optic neuritis. However a 2022 review found that there is no consensus regarding the classification of optic neuritis, and precise diagnostic criteria are not available. In practice, optic neuritis is diagnosed by a combination of features pertaining to symptom manifestation, clinical evaluation, and imaging findings.

Clinical Evaluation

A trained healthcare provider may evaluate a patient for optic neuritis by identifying the presence and degree of visual acuity loss, visual field loss, color vision deficits, and an afferent pupillary defect in the affected eye. The presence, absence, or degree of these manifestations may have associations with specific underlying etiologies of optic neuritis, but are often insufficient to definitively establish a diagnosis of optic neuritis and its associated cause. Fundoscopy is another modality of clinical evaluation that is performed with an

ophthalmoscope Ophthalmoscopy, also called funduscopy, is a test that allows a health professional to see inside the fundus of the eye and other structures using an ophthalmoscope (or funduscope). It is done as part of an eye examination and may be done as part ...

. Findings that support a diagnosis of optic neuritis include optic disc edema, disc inflammation, disc hemorrhages, or ocular inflammation. However, these findings are not always present in every patient, such as in patients with idiopathic optic neuritis which often have normal fundoscopic findings.

MRI

Magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and ...

(MRI) is a robust and sensitive diagnostic modality for the detection of optic neuritis. Imaging of the optic nerve with MRI shows increased signal on the affected side. There is contrast enhancement of the symptomatic optic nerve and sheaths acutely or intrinsic signal increase (looking brighter) within ≥ 3 months. One study found that MRI of the orbits with fat suppression and gadolinium enhancement detected acute optic neuritis lesions in 95% of affected individuals within 20 days of vision loss. Another study found that T2-weighted images with fat suppression and short tau inversion recovery (STIR) detected lesions in up to 89% of acute optic neuritis cases with abnormalities persisting for as long as 6 weeks in 92% of cases. Case-3-mri

Identification of optic nerve, orbital, brain, and meningeal involvement with MRI can also help to better characterize the underlying cause of optic neuritis upon initial evaluation. Unilateral optic nerve involvement is more common MS while bilateral optic nerve involvement is more common in NMOSD and MOGAD. T2-hyperintense and gadolinium-enhancing lesions in multiple regions of the brain and/or spinal cord may be highly suggestive or diagnostic of MS. Such lesions found in the periependymal, fornix, and hypothalamic lesions may be more suggestive of NMOSD. Involvement of the optic chiasm or optic tract are more suggestive of NMOSD-optic neuritis; involvement of the retrobulbar optic nerve can be seen in both NMOSD and MOGAD, but more commonly in MOGAD; perineural optic nerve involvement is often suggestive of MOGAD-optic neuritis, but should not preclude the investigation of other autoimmune or infectious etiologies.

OCT

Optical coherence tomography Optical coherence tomography (OCT) is a high-resolution imaging technique with most of its applications in medicine and biology. OCT uses coherent near-infrared light to obtain micrometer-level depth resolved images of biological tissue or oth ...

(OCT) is a sensitive imaging modality that can reveal subtle pathologic changes in the optic nerve and retina. OCT may reveal changes in thickness of the retinal nerve fiber layers (RNFL) at the peripapillary retina and macula. The OCT shows corresponding optic disc swelling acutely or an inter-eye difference in the thickness of the neurons and their nerves connecting the eye with the brain in above 4-5% within ≥ 3 months after onset. New advancements in OCT technology have allowed for the development of OCT

angiography Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins, and the heart chambers. Modern angiography is perfo ...

which can provide information on the thickness of retinal blood vessels. Whereas OCT has yet to demonstrate identifiable correlations between acute RNFL changes and visual outcomes or treatment responses, OCT angiography may offer novel diagnostic and prognostic insight.

VEP

Visual evoked potential (VEP) is a sensitive test that measures the P100 latency of axonal transmission along the optic nerve. The P100 latency typically peaks at 100 milliseconds after visual stimulus presentation, and a prolonged P100 latency suggests abnormal conduction along this pathway which confirms the presence of optic neuropathy.

Outlook and Treatment

Many patients see full recovery but some see some lasting effects.

Steroids

High dose steroids may be given intravenously (IV) or orally, though IV steroids such as methylprednisolone are typically recommended. Studies, including the Optic Neuritis Treatment Trial (ONTT), support such a guideline based on the statistically significant outcomes showing the efficacy of this treatment modality in restoring visual acuity and lessening ON's other associated symptoms. In most MS-associated optic neuritis, visual function spontaneously improves over 2–3 months, and there is evidence that

corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...

treatment does not affect the long term outcome. However, for optic neuritis that is not MS-associated (or atypical optic neuritis) the evidence is less clear and therefore the threshold for treatment with intravenous corticosteroids is lower. Intravenous corticosteroids also reduce the risk of developing MS in the following two years in patients with MRI lesions; but this effect disappears by the third year of follow up. Paradoxically, oral administration of corticosteroids in this situation may lead to more recurrent attacks than in non-treated patients (though oral steroids are generally prescribed after the intravenous course, to wean the patient off the medication). This effect of corticosteroids seems to be limited to optic neuritis and has not been observed in other diseases treated with corticosteroids. A Cochrane

systematic review A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from published studies on ...

studied the effect of corticosteroids for treating people with acute optic neuritis. Specific corticosteroids studied included intravenous and oral methylprednisone, and oral

prednisone Prednisone is a glucocorticoid medication mostly used to immunosuppressive drug, suppress the immune system and decrease inflammation in conditions such as asthma, COPD, and rheumatologic diseases. It is also used to treat high blood calcium ...

. The authors conclude that current evidence does not show a benefit of either intravenous or oral corticosteroids for rate of recovery of vision (in terms of visual acuity, contrast sensitivity, or visual fields). There are a number of reasons why this might be the case.

Immunosuppressants

Immunosuppressants may also be used in treatment.

Pain relief

Pain relief may also be used.

Epidemiology

Optic neuritis typically affects young adults ranging 18–45 years of age, with a mean age of 30–35 years. There is a strong female predominance. The annual incidence is approximately 5/100,000, with a prevalence estimated to be 115/100,000 (0.12%).

Society and culture

Charles Dickens Charles John Huffam Dickens (; 7 February 1812 – 9 June 1870) was an English novelist, journalist, short story writer and Social criticism, social critic. He created some of literature's best-known fictional characters, and is regarded by ...

' ''

Bleak House ''Bleak House'' is a novel by English author Charles Dickens, first published as a 20-episode Serial (literature), serial between 12 March 1852 and 12 September 1853. The novel has many characters and several subplots, and is told partly by th ...

'', the main character, Esther Summerville, has a transient episode of visual loss, the symptoms of which are also seen in people who have optic neuritis. Legal historian William Searle Holdsworth suggested that the events in ''Bleak House'' took place in 1827. In an episode of '' Dr. Quinn, Medicine Woman'' ("Season of Miracles", season five), Reverend Timothy Johnson is struck blind by optic neuritis on Christmas Day 1872. He remains blind for the duration of the series.

References

External links

Diagnosis and classification of optic neuritis
translated into 116 languages and free for download {{Authority control Autoimmune diseases Disorders of optic nerve and visual pathways