What is the best treatment for retrobulbar neuritis?

Retrobulbar neuritis can be acute or chronic. The patient's vision will be significantly reduced, and in severe cases, the patient will lose response to all light. This disease should be distinguished from astigmatism and hyperopia. Once diagnosed, it can be treated surgically with very good results.

1. Treatment methods

Same as optic neuritis. For severe cases that have not responded to hormone treatment, the maxillary sinus approach can be used to open the ethmoid and sphenoid sinuses, and the lower wall of the optic canal can be removed under a surgical microscope to decompress the optic nerve, improve neurotrophy, and facilitate the recovery of optic nerve function. Generally, good results can be achieved in the acute phase, but in severe cases, it can lead to atrophy of the temporal side of the optic nerve or even complete atrophy and blindness. The chronic phase develops slowly and is mostly bilateral. Delayed treatment or prolonged course of the disease often leads to significant atrophy of the temporal side of the optic nerve, and the prognosis is worse on the left.

2. Symptoms and Signs

Typical cases are easy to diagnose based on visual acuity and fundus, especially visual field examination. Color contrast sensitivity test and VEP examination have certain auxiliary diagnostic significance. Abnormal cells in cerebrospinal fluid, increased γ-globulin, increased viral antibody titer, etc. can be seen. Multiple sclerosis should be suspected. 90% of monoclonal antibodies in cerebrospinal fluid can be increased, but nonspecific HLA-A3 and B7 are also helpful for diagnosis.

It usually occurs in one eye but may affect both eyes. It often presents with a sharp decrease in vision, or even loss of light perception, moderately dilated pupil, slow or absent direct reaction to light, traction pain or deep orbital pain during eye movement, and a normal fundus in the early stage. In the late stage, there may be varying degrees of discoloration on the temporal side of the optic disc, central, paracentral, and dumbbell-shaped dark spots in the visual field, and a reduction in the peripheral visual field. Emphasis should be placed on checking the central 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 baths, and improves at colder temperatures or when drinking ion drinks. This phenomenon is called Unthoff's sign, which is more common in optic neuritis caused by multiple sclerosis and Leber's disease, and can also be seen in other optic neuropathies. It is speculated that this sign is related to the direct interference of increased body temperature with axonal conduction and the release of chemical substances.

3. This disease should be considered to be differentiated from the following diseases:

1. People with refractive errors, especially hyperopia and astigmatism, may experience eye pain, headache and blurred vision. Optic disc changes are similar to optic discitis and are easily misdiagnosed. Optometry and retinoscopy can confirm the diagnosis, and wearing glasses may be a symptom of sexually transmitted diseases.

2. Thin corneal opacity or mild confusion of the posterior lens capsule is mostly caused by negligence in clinical examination and can be confirmed by slit lamp examination.

3. There is no change in the hysterical amaurosis pupil, but it has paroxysmal characteristics. The visual field examination shows spiral shrinkage and there is an obvious history of inducing factors. It can be treated through suggestive therapy.

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

5. Intracranial tumors, especially space-occupying lesions in the sella turcica area, may present as retrobulbar neuritis changes in the early stages. Visual field and head X-rays can aid in diagnosis, while head CT and MRI are more helpful for early detection.