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Clinical Features and Prognosis

Aki Kawasaki, MD; Valerie A. Purvin, MD

Arch Ophthalmol. 2009;127(1):76-81.

Objectives  To describe the clinical features of idiopathic chiasmal neuritis in a large cohort of patients and to report their visual and neurologic outcomes.

Design  A retrospective medical record review of consecutive patients with chiasmal neuritis at a single institution. Patients with clinical or radiographic evidence of inflammation involving the intraorbital optic nerve and patients with a systemic inflammatory or neoplastic disorder were excluded.

Results  Twenty patients were identified (14 female, 6 male; mean age, 37 years). Visual acuity at initial examination ranged from 20/15 to light perception. Progressive visual loss beyond 1 month was documented in 1 patient. Twelve of 15 patients who underwent magnetic resonance imaging demonstrated chiasmal enlargement and/or enhancement; 6 patients had 1 or more white matter lesions. Follow-up time ranged from 2 weeks to 22 years, with a mean of 5.7 years. The final median visual acuity was 20/20 (range, 20/15-20/50) and visual fields were normal or improved. Of 15 patients with a minimum follow-up interval of 1 year, 6 developed multiple sclerosis.

Conclusions  The demographic and clinical features of idiopathic chiasmal neuritis resemble those of idiopathic optic neuritis. Visual prognosis is excellent. In this series, 40% of patients subsequently developed multiple sclerosis.

Author Affiliations: Department of Neuro-Ophthalmology, Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland (Dr Kawasaki); and Neuro-Ophthalmology Section, Midwest Eye Institute, Departments of Ophthalmology and Neurology, Indiana University Medical Center, Indianapolis (Dr Purvin).

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