Editing Optic neuritis (section)

== Outlook and Treatment ==

Many patients see full recovery but some see some lasting effects.<ref name="auto2"/><ref>{{cite web | url=https://www.mssociety.org.uk/about-ms/signs-and-symptoms/eyes-and-sight/optic-neuritis#:~:text=After%20optic%20neuritis%2C%20your%20vision,when%20you%20get%20hot%2C%20too. | title=Optic Neuritis - Symptoms, Treatment & Recovery &#124; MS Society }}</ref><ref>{{Cite web| title=Optic Neuritis | url=https://mft.nhs.uk/app/uploads/sites/2/2019/10/REH-173.pdf | archive-url=https://web.archive.org/web/20220707131618/https://mft.nhs.uk/app/uploads/sites/2/2019/10/REH-173.pdf | archive-date=2022-07-07}}</ref>

=== Steroids ===
High dose steroids may be given intravenously (IV) or orally, though IV steroids such as methylprednisolone are typically recommended.<ref name="auto2"/> Studies, including the Optic Neuritis Treatment Trial (ONTT), support such a guideline based on the statistically significant outcomes showing the efficacy of this treatment modality in restoring visual acuity and lessening ON's other associated symptoms.<ref name=":22"/>

In most MS-associated optic neuritis, visual function spontaneously improves over 2–3 months, and there is evidence that [[corticosteroid]] treatment does not affect the long term outcome. However, for optic neuritis that is not MS-associated (or atypical optic neuritis) the evidence is less clear and therefore the threshold for treatment with intravenous corticosteroids is lower.<ref name="Petzold_20222"/> Intravenous corticosteroids also reduce the risk of developing MS in the following two years in patients with MRI lesions; but this effect disappears by the third year of follow up.<ref name="The effect of corticosteroids for a">{{cite journal | vauthors = Beck RW, Cleary PA, Trobe JD, Kaufman DI, Kupersmith MJ, Paty DW, Brown CH | title = The effect of corticosteroids for acute optic neuritis on the subsequent development of multiple sclerosis. The Optic Neuritis Study Group | journal = The New England Journal of Medicine | volume = 329 | issue = 24 | pages = 1764–1769 | date = December 1993 | pmid = 8232485 | doi = 10.1056/NEJM199312093292403 | doi-access = free }}</ref>

Paradoxically, oral administration of corticosteroids in this situation may lead to more recurrent attacks than in non-treated patients (though oral steroids are generally prescribed after the intravenous course, to wean the patient off the medication). This effect of corticosteroids seems to be limited to optic neuritis and has not been observed in other diseases treated with corticosteroids.<ref>{{cite journal | vauthors = Beck RW, Cleary PA, Anderson MM, Keltner JL, Shults WT, Kaufman DI, Buckley EG, Corbett JJ, Kupersmith MJ, Miller NR | title = A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group | journal = The New England Journal of Medicine | volume = 326 | issue = 9 | pages = 581–588 | date = February 1992 | pmid = 1734247 | doi = 10.1056/NEJM199202273260901 | doi-access = free }}</ref>

A [[Cochrane (organisation)|Cochrane]] [[systematic review]] studied the effect of corticosteroids for treating people with acute optic neuritis.<ref name="Vedula">{{cite journal | vauthors = Gal RL, Vedula SS, Beck R | title = Corticosteroids for treating optic neuritis | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 8 | pages = CD001430 | date = August 2015 | pmid = 26273799 | pmc = 4730547 | doi = 10.1002/14651858.CD001430.pub4 }}</ref> Specific corticosteroids studied included intravenous and oral methylprednisone, and oral [[prednisone]]. The authors conclude that current evidence does not show a benefit of either intravenous or oral corticosteroids for rate of recovery of vision (in terms of visual acuity, contrast sensitivity, or visual fields).<ref name=Vedula /> There are a number of reasons why this might be the case.<ref name="The effect of corticosteroids for a"/><ref>{{cite journal | vauthors = Petzold A, Braithwaite T, van Oosten BW, Balk L, Martinez-Lapiscina EH, Wheeler R, Wiegerinck N, Waters C, Plant GT | title = Case for a new corticosteroid treatment trial in optic neuritis: review of updated evidence | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 91 | issue = 1 | pages = 9–14 | date = January 2020 | pmid = 31740484 | pmc = 6952848 | doi = 10.1136/jnnp-2019-321653 | doi-access = free }}</ref>

=== Immunosuppressants ===
Immunosuppressants may also be used in treatment.<ref name="auto2"/>

=== Pain relief ===
Pain relief may also be used.<ref name="auto2"/>