powerpoint presentation about paraonfectious optic neuritis, the effect of Covid-19 and its vaccination on the optic nerve

1. Parainfectious Optic Neuritis
Mostafa El Manhaly
Vitreoretinal Consultant
Msc/PhD/FRCSEd

2. Causes of Optic Neuritis
1. Idiopathic
2. Demylinating disorders
a) Multiple sclerosis
b) Devics disease
c) Schilder disease
d) acute disseminated encephalomyelitis
3. Infectious
sinus related (ethmoiditis) , cat scratch fever , syphilis , lyme disease, cryptococcal
meningitis

3. Parainfectious Optic Neuritis
Definition
Parainfectious optic neuritis is defined when optic nerve inflammation occurs after
presumably/confirmed systemic infectious disease, particularly of viral aetiology;
measles , mumps, chicken pox or following immunisation.
Differential diagnosis is extensive, particularly with other subtypes of optic
neuropathies.
To date, there is limited information about this entity in the literature.

4. Parainfectious Optic Neuritis
Pathogensis
The pathogenesis behind this disease is still uncertain but an autoimmune mechanism
is the most probable cause.

5. Parainfectious Optic Neuritis
Clinical picture
• Children are affected much more frequently than adults.
• Presentation is usually 1–3 weeks after a viral infection,
Acute
Severe
Bilateral
painless visual loss
• Bilateral papillitis is the rule;
occasionally there may be a neuroretinitis or the discs may be normal.

6. Parainfectious Optic Neuritis
• Children tend to manifest visual symptoms sooner after the antecedent
infection
• More often bilaterally
• In conjunction with ADEM (acute disseminated enchpalomyeilitis).
• The causative agent is isolated less frequently in children compared with
adults.

7. Parainfectious Optic Neuritis
Management and prognosis
The prognosis for spontaneous visual recovery is very good, and treatment is not
required in the majority of patients.
However, when visual loss is severe and bilateral or involves an only seeing eye,
intravenous steroids should be considered, with antiviral cover where appropriate.

8. Covid-19

9. Parainfectious Optic Neuritis
Covid-19 era: Postvaccination

10. Parainfectious Optic Neuritis
Covid-19: Myelin Oligodendrocyte Glycoprotein Antibody
MOG antibodies can circulate freely but do not exhibit a pathologic effect, unless they gain
access to the CNS through disruption of the blood– brain barrier, typically as a result of
inflammation or infection
Once access to the CNS is gained, pathology is mediated by T cells and complement-fixing
antibodies, leading to the varied clinical features associated with MOG antibody–mediated
CNS disease, including
• optic neuritis
• transverse myelitis
• encephalitis
• acute disseminated encephalomyelitis (ADEM)

11. Parainfectious Optic Neuritis
MOG associated optic neuritis post-Covid-19
27 male presented with Bilateral, subacute, sequential vision loss
Pain with eye movements preceded the vision symptoms in each eye.
Disc edema
OD HM and RAPD/ OS 20/250
He reported a few days of progressive dry cough before the onset of eye pain and vision loss.
He also endorsed numbness on the soles of his feet and neck discomfort with forward flexion
but denied shooting, electric-like pain.
SARSCoV- 2 polymerase chain reaction (PCR) testing was justified,

12. Lab: Quantiferon TB Gold Plus, rapid plasma reagin,
fluorescent treponemal antibody absorption test, anti-
nuclear antibody, anti-neutrophil cytoplasmic antibodies,
and aquaporin-4 (AQP4) and MOG-IgG cell-based
assays.
(Serum AQP4 antibodies were not detected; however,
MOG-IgG was highly positive at a titer of 1:1,000
1gm IV methylprednisolone was administered daily for 5
days, followed by an oral prednisone taper.
Visual acuity improved rapidly and incrementally to the
level of 20/50 in each eye by the time of discharge on
the seventh day after admission.
revealed avid, uniform enhancement and thickening
of both optic nerves extending from the globe to their
intracranial prechiasmal segments

13. To sum-up
• Parainfectious optic neuritis is commonly related to viral illnesses and post
immunizations.
• It occurs as a bilateral optic nerve affection and more common in children.
• Spontaneous visual recovery is warranted in the majority of cases.
• Covid-19 related optic neuritis with or without MOG antibodies are commonly
seen nowadays and may require systemic steroids in cases with severe
diminution of vision and disc edema.

14. Thank you