Internal Medicine

P1: SBT

0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18

Adult Optic Neuropathies 79

General Measures

■if ICP is elevated, must be lowered

■if intraocular pressure is elevated, must be lowered

■if intraocular inflammation is detected, must be addressed

directly and with anti-inflammatories let the eye docs

decide

■if temporal arteritis is suspected, pt must be begun on steroids, either

high dose PO, at least 80–100 mgm Prednisone daily until results of

temporal artery bx back

■if Optic Neuritis, results of Optic Neuritis Treatment Trial showed

no role for PO steroids, but IV steroids administered in hospital 250

mgm methylprednisolone QID for 3 days, following by 11 days of

tapering oral prednisone had no effect on eventual visual outcome

of eye, but served to decrease likelihood of another neurological

event within the ensuing 2 years, and so decreased risk of patient’s

meeting clinical criterion for Multiple Sclerosis

■if Optic Neuritis is confirmed, CHAMPS study suggests patient may

benefit from long term interferon therapy to further decrease risks

of future neurologic events.

specific therapy

n/a

follow-up

n/a

complications and prognosis

■Once optic atrophy ensues, treatment does not bring back dead

axons, rather, treatment would only serve to protect damaged and

functioning neural tissue

■Often, treatment is directed at protecting the axons that remain,

protecting the other (non-involved) eye, or decreasing likelihood of

a further neurologic/ophthalmolgic event in the future

■Nonetheless, aggressive treatment is often indicated

■Cannot judge visual rehabilitative potential by amount of optic atro-

phy present – a totally pale and white disc may be able to generate

20/20 vision

■Even vision of “hand motion” is much preferred to “no light percep-

tion” by the patient, so do not give up too early

■Many toxic processes are reversible or partially reversible, once

offending agent is discontinued