Most of the cases of retrobulbar neuritis occur in patients who suffer from multiple sclerosis.
Other cases do not have any explanation (they are called “idiopathic retrobulbar neuritis”). After 2 to 8 weeks there may be a spontaneous recovery (called “remission”). This, however, is more in cases that are idiopathic.
With multiple sclerosis there are often several bouts of retrobulbar neuritis and each bout leads to some more scarring in the optic nerve. The final result often is increasing visual loss, optic nerve atrophy and blindness.
Signs and Symptoms
Eye pain is quite prominent as a symptom and this is associated with a rapid loss of vision. The pain is particularly severe with eye movements and is of a deep gnawing character deep behind the eye.
Quite in contrast to optic neuritis the fundus looks normal to the eye specialist in most cases. There can be some dilated blood vessels (hyperemia) in the fundus.
Treatment is difficult as often high doses of corticosteroids have to be used to get a remission of a bout of retrobulbar neuritis. However, when the corticosteroid is weaned the condition can flare up again. As mentioned above, each recurrence leads to more permanent visual loss and optic nerve atrophy, which puts the clinician in a bind.
1. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
2. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier