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Papillitis

DESCRIPTION:(also known as optic neuritis) A general term implying inflammation of the optic nerve, but also includes degeneration or demyelinization of the optic nerve; included retrobulbar neuritis, a condition affecting the optic nerve behind the optic disk (i.e., there are no visible changes of the optic nerve head unless optic atrophy has occurred). Causes include demyelinating diseases (e.g., multiple sclerosis, postinfectious encephaIomyelitis), systemic infections (viral - polio, flu, mumps, measles - and bacterial - pneumonia et. Al.), nutritional and metabolic diseases (diabetes, pernicious anemia, hyperthyroidism), Leber's Disease, secondary complications of inflammatory diseases (e.g., sinusitis, meningitis, tuberculosis, syphilis, chorioretinitis, orbital inflammation), toxic reactions (to tobacco, methanol, quinine, arsenic, salicylates, lead), and trauma. Papillitis is differentiated from papilledema; it is unilateral instead of bilateral, shows less elevation of the nerve head, and sluggish pupillary response. In optic neuritis, there is usually a severe but temporary loss of vision for several days and pain in the eye when moved.

TREATMENT: Treatment is directed toward the underlying cause. Systemic corticosteroids may be helpful, but the tendency without treatment is toward improvement. Visual acuity usually begins to improve in 2-3 weeks, and sometimes returns to normal in a few days.

IMPLICATIONS: Central scotomas are the most common visual field defect, but any unilateral field change is possible. A single attack of optic neuritis is not likely to leave severe damage, but permanent and significant visual loss is probable over a period of years when recurrent attacks are experienced.

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