Optic perineuritis

Abstract

Purpose of reviewThis review paper aims at discussing pathogenesis, etiology, clinical features, management, and prognosis of OPN.Recent findingsOptic perineuritis (OPN) is an inflammatory process primarily involving the optic nerve sheath. Clinically, OPN usually presents with unilateral, gradual decline of visual function, eye pain, and/or pain on eye movements, disc edema and various features of optic nerve dysfunction, including visual field defects. It can mimic typical optic neuritis. In most cases of OPN, the disease is isolated with no specific etiology being identified, however, it can also occur secondary to a wide range of underlying systemic diseases. OPN is clinically diagnosed and radiologically confirmed based on the finding of circumferential perineural enhancement of the optic nerve sheath on magnetic resonance imaging (MRI).SummaryUnlike optic nerve, OPN is not typically self-limited without treatment. High-dose oral corticosteroids are the mainstay of treatment in OPN. The initiation of therapy usually causes rapid and dramatic improvement in signs and symptoms. In general, OPN usually has a relatively good visual prognosis, which is influenced by delays between the onset of visual loss and the initiation of steroid therapy as well as the presence of underlying systemic diseases.

Bilateral retrobulbar optic neuritis combined with optic perineuritis associated with atezolizumab treatment for small cell lung carcinoma

“…Based on current case reports, 2,3 OirAEs associated with atezolizumab mainly include uveitis, retinitis, myositis, and myasthenia gravis. 4,5 We are only aware of three cases of ON that were side effects of such medications, [6][7][8] two of which had bilateral edema of the optic disc, and the other case had unilateral optic disc edema and hypopituitarism. To the best of our knowledge, this is the first report on bilateral retrobulbar ON combined with OPN.…”

“…OPN is an inflammatory process primarily involving the optic nerve sheath and can occur in a mass of underlying systemic diseases, such as infectious, inflammatory, demyelinating, and autoimmune diseases, as well as malignancies or paraneoplastic syndrome. 8 We have made thorough efforts to exclude all these entities. OPN has also been found in immunocompetent patients because a robust inflammatory response may be generated around the optic nerve sheath.…”