Retrobulbar Optic Neuropathy: From the Neurologist’s Approach

Retrobulbar Optic Neuropathy: “Neither the Patient nor the Doctor Can See”

“…As RION is a result of the retrobulbar ischemic process and the endothelial cell injury from radiation, OD usually seems as normal with ophthalmoscopy in the acute phase, however, it can be observed as swollen. 3,4,25…”

“…1,2 However, it may occur especially in early stages or the beginning of the disease in the manner of the retro-bulbar optic neuropathy (RBON) characterized with normal OD appearance with above mentioned visual symptoms. 3,4 Retro-bulbar optic neuropathy presents with the loss of visual acuity or/and contrast sensitivity, acquired color vision deficiency (CVD), sometimes ocular pain induced by the eye movements without OD edema. 3,4 The injury site of the pathologic process in RBON is behind the OD, in the other words, behind the lamina cribrosa, in the intra-orbital, intra-canalicular or intracranial parts of the optic nerve.…”

“…3,4 Retro-bulbar optic neuropathy presents with the loss of visual acuity or/and contrast sensitivity, acquired color vision deficiency (CVD), sometimes ocular pain induced by the eye movements without OD edema. 3,4 The injury site of the pathologic process in RBON is behind the OD, in the other words, behind the lamina cribrosa, in the intra-orbital, intra-canalicular or intracranial parts of the optic nerve. RBON may develop following demyelinating, compressive, infiltrative, inflammatory, traumatic, and ischemic events involving the optic nerve.…”

“…[3][4][5][6] The optic neuropathies such as retrobulbar optic neuritis (RON), traumatic optic neuropathy (TrON), toxic optic neuropathy (TxON), posterior ischemic optic neuropathy (PION), compressive optic neuropathy (CON), radiationinduced optic neuropathy (RION) which may cause normal OD appearance may be included in RBON. [3][4][5][6] Additionally, ODs may be observed as normal in Stage 0 papilledema. 7 Actually, RBONs are the causes of the classic phrase "neither the patient nor the doctor does not see".…”

“…Unilateral RBON include RON, CON and infiltrative optic neuropathy related with neoplastic diseases such as leukaemia, multiple myeloma or lymphoma while TxONs including tobacco-alcohol induced optic neuropathy, nutritional optic neuropathy (vitamin B12 and folate deficiency), drug-induced optic neuropathy, and Leber's hereditary optic neuropathy (LHON) can cause the appearance of bilateral normal ODs. [3][4][5][6] Retrobulbar optic neuropathies A list of the RBONs and their typical OD appearances were given in (Table 1).…”