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Optic neuritis with potential for poor outcome
  1. Sarah A Cooper1,
  2. Sara Geraldine Leddy1,
  3. Nicholas Tom Skipper2,
  4. Victoria J M Barrett3,
  5. Gordon T Plant4
  1. 1 Neurology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
  2. 2 Neuroradiology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
  3. 3 Ophthalmology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
  4. 4 University College London, London, UK
  1. Correspondence to Dr Sarah A Cooper, Neurology Department, University Hospitals Sussex NHS Foundation Trust, Brighton, UK; sarah.cooper56{at}


The Optic Neuritis Treatment Trial previously reported that corticosteroids accelerated visual recovery in optic neuritis (ON) without improving outcome. This finding related largely to multiple sclerosis (MS), and subsequently neurologists tended to await spontaneous recovery in ON. Since then, non-MS cases of ON have been identified with antibodies to aquaporin-4 (AQP4) or myelin oligodendrocyte glycoprotein (MOG). These disorders can closely mimic multiple sclerosis-associated or idiopathic demyelinating optic neuritis (MS/IDON) initially but risk a worse visual outcome. Scrutinising the clinical features and neuroimaging often enables differentiation between MS/IDON and other causes of ON. Early treatment with high-dose corticosteroids is an important determinant of visual outcome in non-MS/IDON. Prompt use of plasma exchange may also save sight. In this review, we contrast the presentations of myelin oligodendrocyte glycoprotein associated optic neuritis (MOG-ON) and aquaporin 4 associated optic neuritis (AQP4-ON) with MS/IDON and provide an approach to acute management while awaiting results of antibody testing.


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  • Contributors SC, VJMB and GTP formulated the idea for the article. All authors contributed significantly to the content of the manuscript, reviewed the drafts and provided feedback.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed by Ed Margolin, Toronto, Canada, Christian Lueck, Canberra, Australia, and Jacqueline Palace, Oxford, UK.

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    Phil E M Smith Geraint N Fuller

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