What are the common symptoms of retrobulbar neuritis?

Retrobulbar neuritis is a type of optic neuritis, and there is also intrabulbar optic neuritis. It usually occurs in one eye. The patient's vision will drop sharply, the pupil will dilate, and the reaction to light will be particularly slow. It must be diagnosed and treated in time.

1. Clinical manifestations

It usually occurs in one eye but may affect both eyes, often presenting as a rapid decrease in vision or even loss of light perception. The pupils are moderately dilated and have a slow or absent reaction to direct light. There is traction pain or deep orbital pain when the eye moves. The fundus is normal in the early stage, but in the late stage, there may be varying degrees of color loss on the temporal side of the optic disc. There are central, paracentral and dumbbell-shaped dark spots in the visual field, and a reduction in the peripheral visual field may also be seen. Emphasis should be placed on checking the central visual field rather than the peripheral visual field, and emphasis should be placed on using red and small sight marks whenever possible. Temporary blurred vision occurs during exercise or hot bathing, while vision improves in cooler temperatures or when drinking beverages. This phenomenon is called Unthoff's sign. This sign is more common in optic neuritis caused by multiple sclerosis and Leber's disease, but can also be seen in other optic neuropathies. It is speculated that this sign is related to the fact that increased body temperature can directly interfere with axonal conduction and the release of chemical substances.

2. Differential Diagnosis

Optic neuritis should be considered in the differential diagnosis of the following diseases:

1. Refractive error

Especially those with hyperopia and astigmatism may experience eye pain, headache and blurred vision. Changes in the optic disc are similar to optic discitis and are easily misdiagnosed. Optometry and retinoscopy can confirm that wearing glasses can treat symptoms of sexually transmitted diseases.

2. Thin corneal opacity or mild confusion of the posterior lens capsule

It is mostly caused by negligence in clinical examination and can be confirmed by slit lamp examination.

3. Hysterical amaurosis

There is no pupil change and the symptoms are paroxysmal. Visual field examination showed spiral shrinkage. There is a clear history of predisposing factors. It can be treated through suggestion therapy.

4. Cheating

Although the patient complains of obvious visual impairment, long-term objective examinations have no positive findings. Various blindness fraud tests can help to identify the patient, and a normal VEP can rule it out immediately.

5. Intracranial tumors

Especially for space-occupying lesions in the sella turcica area, they may present as retrobulbar optic neuritis changes in the early stage. Visual field and skull X-ray can help with diagnosis, while skull CT and MRI can be more helpful for early detection.