Granadier R J
Beaumont Eye Institute, William Beaumont Hospital, Royal Oak, Michigan, USA.
Dis Mon. 2000 Aug;46(8):508-32. doi: 10.1016/s0011-5029(00)90013-0.
Optic neuritis is a common cause of acute visual loss. It is typified by sudden onset of visual impairment and pain with eye movements, followed by spontaneous recovery of vision over several months. Pathologically, optic neuritis is an acute demyelinating event affecting the optic nerve. Objective physical findings are typically few, including an afferent pupillary defect or Marcus-Gunn pupil, whereas subjective psychophysical findings abound (ie, diminished central visual acuity, color vision, decreased contrast sensitivity, and visual field abnormalities). These characteristics have made the diagnosis of optic neuritis based solely on clinical grounds disquieting to practitioner and patient alike. In addition, the fact that optic neuritis is often associated with multiple sclerosis as the first clinical manifestation of disease gives further reason for both patient and physician anxiety. The serious nature of visual loss and the consequences of making the diagnosis of optic neuritis has given rise to extensive testing and expensive treatments. This review is intended to explore our current state of knowledge with regard to (1) clinical presentation, (2) ancillary testing, (3) therapeutic intervention, and (4) associated disease, specifically the risk for multiple sclerosis in the patient who presents with an acute optic neuritis. Finally, a suggestion guide for informing the patient and addressing his or her concerns will be presented.
视神经炎是急性视力丧失的常见原因。其典型表现为视力突然下降以及眼球运动时疼痛，随后在数月内视力自发恢复。在病理上，视神经炎是一种影响视神经的急性脱髓鞘病变。客观的体格检查结果通常较少，包括传入性瞳孔缺陷或Marcus-Gunn瞳孔，而主观的心理物理学检查结果则较多（即中心视力下降、色觉减退、对比敏感度降低和视野异常）。这些特征使得仅基于临床依据诊断视神经炎让从业者和患者都感到不安。此外，视神经炎常与多发性硬化症相关，作为疾病的首发临床表现，这进一步加剧了患者和医生的焦虑。视力丧失的严重性以及诊断视神经炎的后果导致了广泛的检查和昂贵的治疗。本综述旨在探讨我们目前在以下方面的知识状况：（1）临床表现，（2）辅助检查，（3）治疗干预，以及（4）相关疾病，特别是急性视神经炎患者发生多发性硬化症的风险。最后，将给出一份告知患者并解决其担忧的建议指南。
