De Lott Lindsey B
Continuum (Minneap Minn). 2025 Apr 1;31(2):381-406. doi: 10.1212/cont.0000000000001545.
This article highlights the clinical features, evaluation, and management of optic neuropathies commonly encountered in clinical practice.
Optic neuropathies encompass all conditions affecting the optic nerve, including those caused by ischemia, inflammation (including infections and autoimmune causes), elevated intracranial pressure, compression and infiltration, toxins, nutritional deficiencies, and hereditary diseases. Surgical and medical treatments targeting the specific causes of optic neuropathies are rapidly expanding, such as surgical options to address papilledema in patients with elevated intracranial pressure and the development of gene therapies for hereditary optic neuropathies. These advances underscore the importance of swift and accurate assessments to identify the cause of optic nerve dysfunction. The evaluation of the patient with an optic neuropathy begins with a careful history and examination. Signs of optic nerve dysfunction include decreased visual acuity, color vision impairment, a relative afferent pupillary defect in the affected eye, and visual field deficits. Neuroimaging of the orbits is one of the most useful tests in determining the cause of an optic neuropathy. Additional diagnostic testing and the formulation of a treatment plan should be guided by the differential diagnosis.
Optic neuropathies are often misdiagnosed because of errors in eliciting or interpreting the history and physical examination. A systematic approach to identifying the clinical manifestations distinctive to specific optic neuropathies is imperative for directing diagnostic assessments, formulating tailored treatment regimens, and identifying broader central nervous system and systemic disorders.
