Optic Neuritis Diagnosis and Characteristics

Clinical Presentation and Diagnostic Criteria

• The American College of Radiology suggests that the classic triad of unilateral eye pain, subacute vision loss, and impaired color vision is indicative of optic neuritis in a young adult 1
• The American Heart Association, as published in Stroke, notes that retinal infarction presents differently, with sudden, painless monocular vision loss, and impaired color vision proportional to visual acuity loss, typically occurring in older patients with vascular risk factors 2

Differential Diagnosis and Examination Findings

• The American Heart Association, as published in Stroke, recommends distinguishing optic neuritis from anterior ischemic optic neuropathy (AION), which is painless, occurs in older patients, has sudden onset, and shows altitudinal visual field defects rather than central scotomas 2

Imaging and Diagnostic Next Steps

• The American College of Radiology recommends MRI of the orbits and brain without and with contrast as the primary imaging study to evaluate for abnormal enhancement and signal changes within the optic nerve, and to assess for intracranial demyelinating lesions 1