Information on the following diseases can be found in the Related Disorders section of this report:

• Giant Cell Arteritis
• Multiple Sclerosis
• Retrobulbar Neuritis

The symptoms of papillitis include loss of vision, pain in the eye, and interference with accurate color vision (dyschromatopsia).

Individuals with papillitis usually experience unilateral loss of vision. That is, they lose sight in one eye (about 70% of cases), usually within a short time (a few hours) of having become aware of diminished sight. This condition is usually rapidly progressive.

The intensity of vision impairment varies from case to case, ranging from slight visual deficiency to complete loss of light perception. In addition, affected individuals experience a reduction in color perception. In some cases, spontaneous recovery may occur. However, in other cases, permanent visual impairment may result if the underlying cause is not detected or treated. Papillitis may occur for unknown reasons, after a viral illness, or due to or in association with a number of different underlying disorders or other factors.

There are many possible causes of papillitis. These include diseases that result in damage to the lining of nerves (demyelinating diseases) such as multiple sclerosis and encephalomyelitis; viral or bacterial infections such as polio, measles, pneumonia, or meningitis; nutritional or metabolic disorders such as diabetes, pernicious anemia, and hyperthyroidism; secondary complications of other diseases; reactions to toxic substances such as methanol, quinine, salicylates, and arsenic; and trauma.

In patients over 60 years of age, a common cause of papillitis is temporal arteritis (giant cell arteritis). In such cases, papillitis can spread to the other eye resulting in bilateral blindness.

Papillitis affects males and females in equal numbers and can occur at any age. A percentage of people with papillitis may eventually be diagnosed with multiple sclerosis. (for more information on this disorder, see the Related Disorders section of this report.)

The following disorders may be associated with papillitis.

Giant cell arteritis is a chronic inflammatory disease of the branches of the aortic arch. This disorder is found principally in the temporal and occipital arteries, but may develop in almost any of the large arteries. It rarely involves veins. Papillitis may occur in people with giant cell arteritis. (For more information on this disorder, choose "Arteritis, Giant Cell" as your search term in the Rare Disease Database.)

Multiple sclerosis is a chronic disease of the brain and spinal cord (central nervous system) which may be progressive, relapsing and remitting, or stable. People with MS have small nerve lesions called plaques that may form randomly throughout the brain and spinal cord. These patches prevent proper transmission of nerve signals and thus result in a variety of neurological symptoms. (For more information on this disorder, choose "Multiple Sclerosis" as your search term in the Rare Disease Database.)

Retrobulbar neuritis is an inflammation of that portion of the optic nerve that lies behind the eyeball. Many cases of this disease are caused by multiple sclerosis while others may be due to viral or infectious disorders. In most cases there may be no apparent cause. This disease usually affects one eye and is characterized by pain associated with movement of the eye, headache and a rapid and progressive loss of vision.

Diagnosis
Diagnostic testing may include testing for visual acuity, testing for color vision, examination of the optic disc by means of ophthalmoscopy and magnetic resonance imaging.

Treatment
If spontaneous remission does not occur in people with papillitis it is usually treated with the corticosteroid drugs prednisone or methylprednisolone. Other treatment is symptomatic and supportive.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government website.

For information about clinical trials being conducted at the National Institutes of Health (NIH) Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

MidAmerica Neuroscience Institute is currently recruiting patients experiencing a first "demyelinating event" for a clinical trial. For information, go to www.clinicaltrial.gov or contact:

Laurie A. Dressman, RN, BA at 816-753-8800 ext 124, at
MidAmerica Neuroscience Institute
Kansas City, MO 64108

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REVIEW ARTICLES
Myers TD, Smith JR, Wertheim MS, et al. Use of corticoid sparing systemic immunosuppression for treatment of corticoid dependent optic neuritis not associated with demyelinating disease. Br J Ophthalmol. 2004;17:3-8.

Margalit E, Sadda SR. Retinal and optic nerve diseases. Artif Organs. 2003;27:963-74.

Parisi V. Correlations between morphological and functional retinal impairment in patients affected by ocular hypertension, glaucoma, demyelinating optic neuritis and Alzheimer’s disease. Semin Ophthalmol. 2003;18:50-57.

Kesler A, Pianka P. Toxic optic neuropathy. Curr Neurol Neurosci Rep. 2003;3:410-14.

Chan JW. Optic neuritis in multiple sclerosis. Ocul Immunol Inflamm. 2002;10:161-86.

JOURNAL ARTICLES
Pirko I, Blauwet LK, Lesnick TJ, et al. The natural history of recurrent optic neuritis. Arch Neurol. 2004;61:1401-05

[No authors listed]. Neurologic Impairment 10 Years after Optic Neuritis. Arch Neurol. 2004;61:1386-89.

Hickman SJ, Toosy AT, Miszkiel KA, et al. Visual recovery following acute optic neuritis: A clinical, electrophysiological and magnetic resonance imaging study. J Neurol. 2004;251:996-1005.

Lim ET, Grant D, Pashenkov M, et al. Cerebrospinal fluid levels of brain specific proteins in optic neuritis. Mult Scler. 2004;10:261-65.

Craenen G, Brown SM, Freedman KA, et al. Rapid, painless unilateral vision loss in a 37-year-old healthy woman. Surv Ophthalmol. 2004;49:343-48.

Beck RW, Gal RL, Bhatti MT, et al. Visual function more than 10years after optic neuritis: experience of the optic neuritis treatment trial. Am J Ophthalmol. 2004;137:77-83. Errata in: Am J Ophthalmol. 2004;137:following 793. Am J Ophthalmol. 2004;138:following 321.

Fazzone HE, Lefton DR, Kupersmith MJ. Optic neuritis: Correlation of pain and magnetic resonance imaging. Ophthalmology. 2003;110:1646-49.

FROM THE INTERNET
Swallow C. Optic Neuritis. emedicine. Last Updated: July 20, 2004. 9pp.
www.emedicine.com/radio/topic488.htm

Giovannini J, Chrousos G. Pseudopapilledema. emedicine. Last Updated: August 26, 2002. 6pp.
www.emedicine.com/oph/topic615.htm

Papillitis. The Merck Manual. 2004. 2pp.
www.merck.com/mrkshared/mmanual/section8/chapter101/101b.jsp