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