Chiasmal neuritis can be diagnosed based on clinical and imaging findings. Most patients have a good prognosis with good recovery of lost visual acuity.


Diagnostic criteria:

(1) acute visual loss

(2) one or both of the following:

(2a) chiasmal visual field pattern to the visual loss (bitemporal hemianopsia or junctional scotoma)

(2b) inflammation of the optic chiasm on MRI (enlargement and/or enhancement)

(3) exclusion of other explanations


Secondary causes of chiasmal neuritis:

(1) sarcoidosis

(2) autoimmune disease

(3) infection (Epstein-Barr, Lyme disease, tuberculosis)


Idiopathic chiasmal neuritis has a relatively high rate of subsequent multiple sclerosis so these patients should be followed carefully.


Therapy with intravenous methylprednisolone may be effective in reducing the severity of the inflammation.


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