Managing optic neuritis, a common complication of multiple sclerosis (MS), can help you maintain clear and colorful vision while minimizing eye pain.

Optic neuritis is inflammation of the optic nerve, which carries visual information from the eye to the brain. In MS, inflammation can affect the optic nerve and cause an acute optic neuritis episode — a new or sudden flare of symptoms such as eye pain, blurry vision, dimmed or faded colors, or vision loss.

Over 50 percent of people living with MS experience optic neuritis at some point. For some people, it’s the first symptom of MS.

Some people’s vision improves after their first experience with optic neuritis, while others experience lasting vision changes from recurrent (repeated) optic neuritis episodes.

Although optic neuritis symptoms typically go away on their own, seeing your neurologist can ensure you’re managing your MS effectively.

In this article, we’ll cover treatment options for acute and recurrent optic neuritis in people living with MS.

How Long Do Treatments for Optic Neuritis Take To Work?

Treatment with corticosteroids aims to reduce inflammation, not “restore” the nerve immediately. It can help you recover from optic neuritis symptoms faster than you would by waiting it out.

While optic neuritis usually resolves slowly over four to six weeks, treatment with steroids can sometimes improve symptoms in just two weeks.

How Long Might Symptoms Linger After Treatment?

It’s important to note that your symptoms may not fully go away even after you treat acute optic neuritis with steroids. The following symptoms can linger indefinitely, especially if you’ve had repeated optic neuritis episodes:

• Vision that is slightly less clear than before
• Reduced low-contrast vision
• Faded color vision
• Challenges with depth perception

Lingering symptoms might not last forever. You may see continued improvements in your vision for up to a year after acute treatment with steroids.

New and Emerging Optic Neuritis Treatments

For now, the standard acute treatment is high-dose corticosteroids, with plasma exchange considered for steroid-refractory cases.

Health experts are studying new ways of treating optic neuritis that may be just as effective or more effective than the standard steroid treatment. So far, no treatments have proven to be as effective as steroids at treating acute optic neuritis.

However, several new and emerging treatments focus on preventing optic neuritis recurrence and preserving vision.

Remyelination Therapies

As health experts search for new and more effective treatments for acute optic neuritis, remyelination therapies stand out as a possible alternative to steroids. Remyelination therapies aim to help repair the myelin (protective covering) on the optic nerve after an optic neuritis episode.

Possible remyelination therapies for optic neuritis include mesenchymal stem cells (MSCs) and certain monoclonal antibodies that promote myelin repair. Researchers continue to study them in trials to make sure they’re effective for treating people with optic neuritis in MS.

Although research is ongoing, health experts believe remyelination therapies may be most effective for treating optic neuritis within 25 days of symptoms starting. They also believe these treatments may work best for older people and young people with MS who have a preserved central nervous system (brain and spinal cord) structure.

Neuroprotective Treatments

Neuroprotective treatments aim to protect the optic nerve from inflammation-related damage during MS relapses. Heatlh experts are studying several potential neuroprotective treatments for optic neuritis in MS, including erythropoietin and memantine.

Gene Therapy

Gene therapy is a treatment strategy that is advancing quickly and may have the potential to treat acute optic neuritis. A lot more research is needed to find out if it can treat acute optic neuritis effectively, but some health experts believe it may be able to treat currently irreversible vision loss one day.

In one possible approach to gene therapy, neuroprotective gene-encoding proteins are applied directly to the optic nerve. While this treatment is still in the early stages of research, it may help protect the optic nerve from the damage that can cause vision loss.

Recognizing Recurrent Optic Neuritis

If you have MS and develop optic neuritis multiple times, your neurologist may recommend tests to look for other causes of your vision problems. If they determine your recurrent optic neuritis is linked directly to your MS, they may update your MS treatment plan.

Treating Recurrent Optic Neuritis

Managing your MS may help prevent recurrent optic neuritis. Disease-modifying therapies (DMTs), which are commonly prescribed to manage MS, may reduce your risk for future optic neuritis episodes.

DMTs for MS, including monoclonal antibodies, treat MS by limiting inflammation in the nervous system and preventing MS relapses. Some oral, infused, and injectable DMTs may help prevent optic neuritis episodes and minimize the damage they cause to the optic nerve.

Testing and Treating Neuromyelitis Optica Spectrum Disorder

Recurrent optic neuritis is sometimes associated with neuromyelitis optica spectrum disorder. If you have recurrent episodes and your MS treatments haven’t prevented them, your doctor may want to test you for NMOSD.

NMOSD Testing

NMOSD usually causes bilateral optic neuritis (optic neuritis in both eyes). NMOSD can look very similar to MS in some ways, but the conditions are linked to separate antibodies in your immune system.

Telling the difference between NMOSD and MS as a cause of optic neuritis can be challenging because they share so many features. Testing for NMOSD usually starts with a neurological exam. Your doctor may use blood tests or a spinal tap (lumbar puncture) to look for specific antibodies involved in NMOSD.

NMOSD Treatments

Treating NMOSD that causes optic neuritis is slightly different from treating optic neuritis from MS alone.

Acute optic neuritis treatment typically involves high-dose steroids, and you’ll taper off them for a longer time than you would with optic neuritis with MS. You might also receive plasma exchange to cleanse your blood.

Long-term management of recurrent optic neuritis with NMOSD usually involves immunotherapy. If your optic neuritis comes from NMOSD, you won’t take DMTs, as they’re not effective for NMOSD.

Talk to Your MS Specialist

If you have MS and experience any concerning changes to your vision, be sure to tell your neurologist or MS specialist. Optic neuritis typically improves on its own over time, but it’s still important to keep your neurologist informed.

Tell your healthcare team if you notice any of the following in the affected eye:

• Eye pain
• Vision loss in the center of your visual field
• Less vivid color vision
• Less visual acuity (your eyesight may not be as sharp)
• Heat causing your vision to get blurrier, like in the sun or while exercising

Your neurologist can review your current treatment regimen to help prevent recurrent optic neuritis. If you experience vision problems often, they may test you for other conditions that affect the optic nerve or refer you to an ophthalmologist (eye doctor) for further evaluation.

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