What Is It?
Retrobulbar neuritis is a form of optic
neuritis in which the optic nerve, which is at the back of the
eye, becomes inflamed. The inflamed area is between the back
of the eye and the brain. The optic nerve contains fibers that
carry visual information from the nerve cells in the retina to
the nerve cells in the brain. When these fibers become
inflamed, visual signaling to the brain becomes disrupted, and
vision is impaired.
Retrobulbar neuritis can be caused by a
variety of conditions, including:
However, in many cases, the cause is unknown.
Vision loss can be minimal or the disease can result in
The average age of people who develop optic
neuritis is 32. Most are female, and the vast majority also
have pain when they move their eyes. Retrobulbar neuritis
often is an early sign that someone has multiple sclerosis.
Between 20 percent and 40 percent of the 25,000 people who
develop optic neuritis in the United States each year will
develop multiple sclerosis within 10 years.
Symptoms usually worsen for two weeks and then
stabilize. However, the course of the illness varies greatly.
Most cases show some improvement over time, although complete
recovery is rare. Optic neuritis usually affects only one eye,
but both eyes may be affected. Common symptoms include:
- Blurred or dimmed vision
- A blind spot at or near the center of vision
- Color "wash-out" so that colors are less rich
- Pain with eye movement
- Tenderness of the eye to touch or pressure
- Complete blindness in the affected eye
A doctor will use an ophthalmoscope to examine
the back of the eye, particularly the optic disc. This is
where the optic-nerve fibers concentrate before exiting the
eye to extend back toward the brain. In the early stages of
retrobulbar neuritis, the optic disk appears normal. Later, it
may become pale.
The pupil normally becomes smaller
(constricts) in response to light. In retrobulbar neuritis,
this response often is reduced in the affected eye. The doctor
also will test your visual acuity, which frequently is
impaired in the affected eye. The doctor will test your side
vision because, in all cases of retrobulbar neuritis, a
scotoma, a blind or dark spot in the visual field, will be
present. The doctor also may search for associated conditions,
such as infection or multiple sclerosis, after a detailed
discussion about other symptoms and a complete physical
The duration depends on the cause, and in some
people, optic neuritis is a recurrent problem. In some cases,
if the optic nerve is permanently damaged, it can lead to
Because the underlying cause of retrobulbar
neuritis is often unknown, there is no way to prevent it.
Many cases improve without treatment.
Sometimes, corticosteroids, such as prednisone, are used to
treat retrobulbar neuritis. However, the decision as to which
type of therapy must follow an evaluation of the cause of the
When To Call A Professional
Call a doctor if you experience any vision
changes, either suddenly or over time. Pain in or around the
eye, with or without vision loss, also should receive prompt
The prognosis depends on the cause. Cases in
which there is no obvious cause or in which the cause is
multiple sclerosis often improve after two weeks, but the
vision may never completely return to normal.
Retrobulbar neuritis may recur, and many
people with retrobulbar neuritis eventually develop multiple
sclerosis. If an MRI image of the brain is abnormal in a
manner typical of multiple sclerosis at the time of
retrobulbar neuritis, clinically obvious multiple sclerosis is
much more likely than if the MRI is normal.
National Eye Institute
2020 Vision Place
Bethesda, MD 20892-3655
Phone: (301) 496-5248
American Academy of Ophthalmology
P.O. Box 7424
San Francisco, CA 94120
Phone: (415) 561-8500
Fax: (415) 561-8533