bubble_chart Overview

Papillitis refers to local inflammation of the optic disc, commonly occurring in children or young adults, often affecting both eyes, with a relatively good prognosis.

bubble_chart Etiology

Commonly seen in systemic acute or chronic pestilence diseases, such as encephalitis, influenza, measles, cold-damage disease, mumps, subcutaneous nodules, syphilis, etc. It can also be secondary to inflammation of the orbit, sinuses, teeth, and other areas. Idiopathic cases account for about half of domestic cases and are believed to be related to allergic reactions. In children, it is often caused by upper respiratory tract infections.

bubble_chart Clinical Manifestations

Vision deteriorates sharply, potentially leading to blindness within a short period (2–5 days), though some may experience less noticeable vision loss. In the early stages (1–2 days), symptoms include frontal headaches, deep eye and orbital pain, and traction pain during eye movement. The condition rarely persists beyond 10–14 days; otherwise, the diagnosis should be reconsidered. Vision often begins to recover within 1–4 weeks, with improvements continuing for up to 7 months, and 48% of cases show enhancement. Pupils are typically dilated, with sluggish or absent direct light reflexes but preserved indirect light reflexes. Infrared pupillometry provides objective and quantifiable measurements. Pupillary cycle time latency is significantly prolonged. Fundus examination reveals optic disc hyperemia, grade I elevation, blurred margins, obscured lamina cribrosa, and loss of physiological cupping. Peripapillary retinal edema presents as radial striations, with small hemorrhages on the disc surface and margins. Retinal veins appear dilated, tortuous, and sheathed. When retinal edema extends to the macula, accompanied by hemorrhages and exudates, the condition is termed neuroretinitis. Secondary optic atrophy may develop after 4–6 weeks.

bubble_chart Diagnosis

The diagnosis is generally not difficult based on vision, fundus, and visual field examinations, but it should be differentiated from conditions such as optic disc edema (Table 1). Color vision testing has certain auxiliary diagnostic significance and is also valuable for monitoring disease progression and evaluating treatment efficacy. Color vision impairment may improve as the condition improves. Contrast sensitivity testing and visual evoked potentials also hold certain diagnostic value. To rule out the possibility of compressive optic neuropathy, skull X-rays or CT scans should be performed when necessary. For cases of optic neuritis with normal vision, attention should be paid to examining the vitreous for the presence of cells, nerve fiber bundle visual field defects, and the Marcus-Gunn pupil phenomenon. If retinal vein sheathing is observed along with vitreous cells, systemic diseases such as sarcoidosis and multiple sclerosis must be suspected.

bubble_chart Treatment Measures

Find the cause of the disease and eliminate the lesion. In the past, attention was paid to tonsillitis, {|###|}dental caries{|###|}, sinusitis, etc., but in recent years, there has been negligence, and routine examinations should still be conducted. Promptly apply adrenocorticotropic hormone or corticosteroids, starting with a large {|###|}dose{|###|} intravenous drip, and gradually reduce the dosage after effectiveness, then switch to oral administration. In recent years, the use of periocular and retrobulbar injections of corticosteroid {|###|}solution{|###|} has been advocated, as it is considered both effective and capable of preventing or reducing {|###|}side effects{|###|}. The earlier use of heterologous protein fever therapy is no longer employed, but some believe it can be tried when corticosteroids are ineffective. The use of antibiotics depends on the presence of infectious inflammation and is not necessary for routine use, but severe cases should still be treated to prevent irreversible changes in the optic nerve. Other neurotrophic drugs such as vitamin B₁

, B₁₂, ATP, and coenzyme A can also be used. Vasodilators and {|###|}blood-activating and stasis-resolving medicinal{|###|} such as compound formula Salvia and venoruton can be taken orally or administered via intravenous drip. Additionally, cytochrome C and citicoline also show certain effectiveness.

bubble_chart Differentiation

Table 1 Differential Diagnosis Table of Optic Neuropathy

	Optic Papillitis	Optic Disc Edema	Ischemic Optic Disc Disease	Optic Disc Vasculitis Type I	Pseudopapilledema
Cause	Local inflammation, systemic diseases, poisoning, etc.	Increased intracranial pressure, often due to intracranial space-occupying lesions or sexually transmitted diseases	Circulatory disturbance in the posterior ciliary artery supplying the optic disc, leading to acute ischemia and hypoxia of the optic disc	Unknown, mostly considered non-specific inflammation	Congenital developmental anomaly, often seen in hyperopia
Affected Eye	Mostly unilateral	Mostly bilateral, with the affected side more severe	Bilateral, may occur sequentially	Mostly unilateral	Bilateral
Early Vision	Rapid and significant decline	Normal	Normal or grade I decline; sudden decline possible if caused by temporal artery inflammation	Normal or grade I decline	Normal or poor
Optic Disc Swelling Height	Below 3D	Above 3D	Below 3D, anemic edema or localized pallor of the optic disc	Generally less than 3D	No swelling, only blurred disc margins
Peripapillary Hemorrhage and Exudates	Few	More	Grade I	Few	None
Retinal Vessels	Veins not or grade I engorged	Arteries thinner, small veins highly engorged	Arteries narrow and small, or signs of arterial sclerosis	Veins tortuous and dilated, arteries slightly thin	Both arteries and veins may show grade I dilation
Visual Field	Early central scotoma, peripheral visual field constriction, more pronounced color vision defects	Early physiological blind spot enlargement, advanced stage peripheral visual field constriction	Hemianopia or nerve fiber bundle defects connected to the physiological blind spot	Possible physiological blind spot enlargement and corresponding changes	None
Optic Atrophy	Occurs in advanced stage	Occurs in advanced stage	Localized optic nerve atrophy	Generally none, or slight optic disc pallor	None
Prognosis	Generally good	Depends on the underlying cause. Early surgery for intracranial tumors yields good results	better	Good	Correctable with glasses