Infectious Optic Neuropathies: What Should I do Differently?

Optic neuropathies commonly arise as a result of primary or secondary sequelae of infection. When present uveitis, meningitis, retinal inflammation, retinal vasculitis, orbital involvement, or sinus disease may help support an infectious etiology. Infectious agents that are known to affect the optic nerve include a long list of bacteria, virus, protozoa, or fungi. Patients may have unilateral or bilateral optic nerve disease. The optic disc may appear swollen and may be accompanied by neuroretinitis. Alternatively, the patient may present with optic neuropathy or a retrobulbar optic neuritis. Secondary optic nerve disease may also occur due to elevated intracranial pressure associated with meningeal infection. Recovery of vision is highly variable.