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Infectious optic neuropathy (ION), how to recognise it and manage it

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Abstract

Optic neuropathy can be of infectious or non-infectious/idiopathic aetiology. Many infectious organisms can cause optic neuropathy that can be of varied presentation including papillitis, retrobulbar optic neuritis, neuroretinitis, and optic perineuritis. Detailed history, ocular, systemic/neurologic examination along with appropriate laboratory evaluation can help clinicians to identify the infectious agent causing optic neuropathy. In spite of recent advanced techniques in serological testing and molecular diagnostics like polymerase chain reaction (PCR), the identification of these pathogens is still a diagnostic challenge. It is ideal to have an infectious disease (ID) consultant in the management team, as most of these infections are multisystem involving diseases. Most infectious agents can be effectively treated with specific antibiotics, with or without corticosteroid therapy, but visual recovery is highly variable and depends entirely on early diagnosis of the causative agent. This review article will provide an overview of common pathogens involved in ION and will describe their management paradigms.

摘要

视神经病变可为感染性、非感染性或特发性。许多感染性病原体可引起各种视神经病变, 包括乳头炎、球后视神经炎、神经视网膜炎和视神经周围炎。详细病史、眼科、全身/神经学以及适当的实验室检查可帮助临床医生确定导致视神经病变的感染性病原体。尽管目前在血清学检测和分子诊断技术先进, 如聚合酶链式反应(PCR), 但病原体的鉴定仍然是在诊断方面的一个挑战。理想状态下, 治疗团队中应有一名传染病学顾问, 因为感染多涉及多系统。大多数感染性病原体可以使用特定的抗生素有效地治疗, 无论是否合用皮质类固醇治疗, 但视力是否恢复变异性较大, 并且完全取决于对病原体的早期诊断。本综述将提供涉及ION的常见病原体并描述针对其进行管理的范例。

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Fig. 1
Fig. 2: A case of optic disc granuloma that responded well to anti-tuberculous therapy.
Fig. 3: Pizza pie fundus in Cytomegalovirus infection.
Fig. 4: Toxoplasma neuroretinitis with choroiditis.
Fig. 5: Optic neuropathy associated with mucormycosis.

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Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.

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Acknowledgements

We would like to thank Dr. Parthapratim Dutta Majumder, Dr. S Sudharshan, Dr. Arshee S Ahmed, Dr. Sharanya Sarah Abraham, Dr. Vidhya Dharani DM, and Dr. Varsha Backiavathy for contributing cases to this manuscript.

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  1. Department of Neuro-Ophthalmology, Sankara Nethralaya – A Unit of Medical Research Foundation, 18 College Road, Nungambakkam, Chennai, 600 006, India

    Selvakumar Ambika & Padma Lakshmi

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Ambika, S., Lakshmi, P. Infectious optic neuropathy (ION), how to recognise it and manage it. Eye (2024). https://doi.org/10.1038/s41433-024-03152-8

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