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Highlights aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein-associated disease, stressing distinct pathophysiology, prognosis, and management. Explains need for precise terminology and individualized evaluation. Notes multiple sclerosis-related optic neuritis as most common with excellent steroid-responsive visual outcomes, contrasts AQP4 and MOG disease features, and underscores early aggressive therapy for infectious causes.",{"@graph":69,"@context":127},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/optic-neuritis-approach-to-vision-loss/392593/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/optic-neuritis-approach-to-vision-loss/392593.png","ImageObject",300,407,{"name":92,"@type":93},"Aria","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-25",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",13,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119,123],{"name":110,"@type":111,"acceptedAnswer":112},"What is the main purpose of this article on optic neuritis?","Question",{"text":113,"@type":114},"It reviews common inflammatory and infectious optic neuropathies that present as optic neuritis, including newer antibody-defined syndromes and how to distinguish them for appropriate therapy.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How does multiple sclerosis–related optic neuritis typically affect vision and treatment response?",{"text":118,"@type":114},"It is the most common inflammatory demyelinating form, causes short segments of optic nerve inflammation, and generally has an excellent visual prognosis with improvement with or without high-dose steroids.",{"name":120,"@type":111,"acceptedAnswer":121},"Why is distinguishing AQP4-associated and MOG-associated optic neuritis important?",{"text":122,"@type":114},"They have different pathophysiologies and outcomes: AQP4 disease shows more guarded recovery with worse untreated outcomes, while MOG disease often involves optic disc edema, is very steroid sensitive, but tends to recur.",{"name":124,"@type":111,"acceptedAnswer":125},"What key infectious cause is highlighted and what does it require?",{"text":126,"@type":114},"Syphilis incidence has doubled in the last decade; it requires early aggressive therapy to maximize visual recovery.","https://schema.org",{"og:url":83,"og:type":129,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":131,"canonical":83},"index,follow",{"doc_id":133,"site_id":62},392593,1790468768,{"code":4,"msg":5,"data":136},{"doc_id":133,"user_id":137,"nickname":92,"user_avatar":138,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":139,"file_id":140,"file_url":141,"file_type":142,"file_size":143,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":144,"language":145,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":146,"faqs":147,"seo_title":148,"seo_description":67,"update_tm":149,"read_time":150,"preview_page_count":4},2336464648322,"https://ap-avatar.wpscdn.com/avatar/2200025388227c56fec?_k=1778556882303663488","|  |\n| --- |\n|  |\n|  |\n\nDOI: [https://doi.org/10.1212/cont.0000000000001560](https://doi.org/10.1212/cont.0000000000001560)  \nOptic Neuritis  \nBy Eric Eggenberger, DO, MS, FAAN  \nABSTRACT  \nOBJECTIVE: This article reviews the most common and noteworthy inflammatory and infectious optic neuropathies, with an update on newer syndromes.  \nLATEST DEVELOPMENTS: We have entered an era of antibody-assisted definitions of distinct types of optic neuritis, including aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein–associated disease, with distinct pathophysiologies, prognoses, and management options. It is crucial to distinguish between these entities and other common inflammatory (eg, sarcoid or other granulomatous inflammation) or infectious optic neuropathies as appropriate therapy radically differs. These developments highlight the increasing importance of precision terminology as many of these now distinctly defined syndromes have been previously lumped together as “typical or atypical optic neuritis.” An individualized evaluation and treatment approach is required.  \nESSENTIAL POINTS: Multiple sclerosis–related optic neuritis is the most common form of inflammatory demyelinating optic neuritis, causing short segments of optic nerve inflammation, with an excellent visual prognosis and tendency to improve with or without high-dose steroids.  \nAquaporin-4 associated optic neuritis causes longitudinally extensive optic nerve inflammation and has a more guarded prognosis for visual recovery, with poor visual outcomes in untreated patients compared with multiple sclerosis or myelin oligodendrocyte glycoprotein–associated disease. Myelin oligodendrocyte glycoprotein optic neuritis also causes longitudinally extensive optic nerve inflammation with a predilection for optic disc edema and tends to be very steroid sensitive, but recurrent. Infectious optic neuropathies are important to recognize; syphilis incidence has doubled in the last decade and requires early aggressive therapy to maximize visual recovery.  \nINTRODUCTION  \nT  \nhe inflammatory and infectious optic neuropathies are a broad, heterogeneous, and commonly encountered group of diseases producing visual loss (TABLE 4-1) .1,2 Patients with optic neuritis present with decreased vision, relative afferent pupillary defect in the affected eye if unilateral or asymmetric, often with pain with eye  \nmovements, initially normal or swollen optic disc, and usually optic nerve enhancement on orbital MRI. For more information, refer to the articles  \nREVIEW ARTICLE  \n􀀁  \nCONTINUUM AUDIO INTERVIEW AVAILABLE ONLINE  \nCITE AS:  \nCONTINUUM (MIN NEA P M INN) 2025;31(2, NEUROOPHTHALMOLOGY): 407–435.  \nAddress correspondence to Dr Eric Eggenberger, 4500 San Pablo Rd S, Jacksonville, FL 32224, eggenberger.eric@ [mayo.edu](mayo.edu).  \nRELATIONSHIP DISCLOSURE: Dr Eggenberger reports no disclosure.  \nUNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE:  \nDr Eggenberger discusses the unlabeled/investigational use of rituximab and tocilizumab for the treatment of neuromyelitis optic spectrum disorder.  \n© 2025 American Academy of Neurology.  \nCONTINUUM JOURNAL . COM 407  \n|  |\n| --- |\n|  |\n|  |\n\nOPTIC NEURITIS  \n“Approach to Vision Loss” by Nancy J. Newman, MD, FAAN and Valérie Biousse, MD,3 and “Optic Neuropathies” by Lindsey B. De Lott, MD, MS,4 in this issue of Continuum.  \nAlthough the term optic neuritis is often inappropriately applied to any optic neuropathy, in this article the term is used to signify inflammatory or infectious optic neuropathies, among which mechanisms and causes vary greatly. Attention to precise terminology will only become more important as further distinct syndromes are defined, with dissimilar diagnostic criteria, courses, prognoses, and treatments. The nonspecific term atypical optic neuritis is best avoided as it lacks a defined pathophysiology, course, or treatment implications, often inappropriately im","cbCaim9kyBci4ORs","https://ap.wps.com/l/cbCaim9kyBci4ORs","pdf",1919383,29,"English","# Abstract\n# Introduction\n# Inflammatory Demyelinating Optic Neuropathies\n## Multiple Sclerosis–associated or Idiopathic Demyelinating Optic Neuritis\n# Table 4-1 Inflammatory Demyelinating Optic Neuritis","[{\"question\":\"What is the main purpose of this article on optic neuritis?\",\"answer\":\"It reviews common inflammatory and infectious optic neuropathies that present as optic neuritis, including newer antibody-defined syndromes and how to distinguish them for appropriate therapy.\"},{\"question\":\"How does multiple sclerosis–related optic neuritis typically affect vision and treatment response?\",\"answer\":\"It is the most common inflammatory demyelinating form, causes short segments of optic nerve inflammation, and generally has an excellent visual prognosis with improvement with or without high-dose steroids.\"},{\"question\":\"Why is distinguishing AQP4-associated and MOG-associated optic neuritis important?\",\"answer\":\"They have different pathophysiologies and outcomes: AQP4 disease shows more guarded recovery with worse untreated outcomes, while MOG disease often involves optic disc edema, is very steroid sensitive, but tends to recur.\"},{\"question\":\"What key infectious cause is highlighted and what does it require?\",\"answer\":\"Syphilis incidence has doubled in the last decade; it requires early aggressive therapy to maximize visual recovery.\"}]","Optic Neuritis - Approach to Vision Loss | PDF",1790371327,73]