13.5 Optic neuritis

Previously used term:
Retrobulbar neuritis.

Pain behind one or both eyes caused by demyelination of the optic nerve(s) and accompanied by impairment of central vision.

Diagnostic criteria:
A. Unilateral or bilateral headache fulfilling criterion C
B. Clinical, electrophysiological, imaging and/or laboratory evidence confirming the presence of optic neuritis
C. Evidence of causation demonstrated by both of the following:

    1. headache has developed in temporal relationship to optic neuritis
    2. headache has either or both of the following features:

      a) localized in retro-orbital, orbital, frontal and/or temporal regions
      b) aggravated by eye movement

D. Not better accounted for by another ICHD-3 diagnosis.

13.5 Optic neuritis is often a manifestation of multiple sclerosis. Pain may precede impairment of vision. Clinical series report the prevalence of head pain in optic neuritis to be about 90%.

There is a high incidence (90%) of pain with eye movement when there is an orbital segment enhancement in cranial MRI, and a high probability (70%) of no such pain when there is no enhancement.