Diseases of the Eye with Systemic Involvement and /or Acute Presentation

  • Natalia G Vallianou Evangelisnos General Hospital
  • Christos Kazazis Internist
Keywords: optic neuritis, multiple sclerosis, age-related macular degeneration, diabetic retinopathy, glaucoma, uveitis

Abstract

Opticneuritis is defined as an inflammation of the optic nerve, which is mostlyidiopathic. However, it can be associated with variable causes: demyelinatinglesions, autoimmune disorders, infectious conditions, compressive, toxic,metabolic and hereditary conditions. It is divided intoarteritic, which is commonly seen in temporal arteritis/polymyalgia rheumaticaand non arteritic, which is associated with advanced age, atherosclerosis,hypertension and hyperlipidemia. Among demyelinating disorders, multiplesclerosis is the most common cause. The term optic neuritis is indicated bysub-acute unilateral painful visual loss mostly in a young healthy female andby excluding glaucoma. The clinical diagnosis of optic neuritis consists of theclassic triad of visual loss, periocular pain and dyschromatopsia whichrequires careful ophthalmic, neurologic and systemic examinations todistinguish between typical and atypical optic neuritis. In neuromyelitis optica,optic neuritis is initially misdiagnosed as optic neuritis in multiplesclerosis or other conditions such as ischemic optic neuritis and Leber’sdisease. Therefore, differential diagnosis is necessary to make a propertreatment plan. According to Optic Neuritis Treatment Trial, the first line oftreatment is intravenous methylprednisolone with faster recovery and lesschance of recurrence of optic neuritis and conversion to multiple sclerosis.Apart from optic neuritis of various causes, loss of vision could be due toglaucoma or uveitis. Glaucoma is optic nerve damage due to an interruption ofthe production and/or abduction of vitreous gel of the eye. Uveitis refers to a group of heterogeneous diseasesthat share the features of intraocular inflammation, but whose etiologies includeidiopathic autoimmune disease, infections and masquerade syndromes. Acute retinal necrosis and detachment may have a debilitatingeffect on vision and must be rapidly diagnosed and confronted, too. Theabove-mentioned clinical entities, their etiologies and current therapies arebriefly discussed in this review.Key-words: optic neuritis; multiple sclerosis; age-relatedmacular degeneration; diabetic retinopathy; glaucoma; uveitisAbbreviations: AMD (age-related macular degeneration); DR (diabeticretinopathy); DME (diabetic macular edema); AGEs (advanced end glycationproducts)

Author Biographies

Natalia G Vallianou, Evangelisnos General Hospital
Christos Kazazis, Internist
Published
2013-06-15
Section
REVIEWS