Clinical profile and outcomes of optic neuritis in an HIV prevalent urban community in South Africa

Purpose To determine the clinical profile, causes and response to corticosteroid therapy in patients admitted and treated for optic neuritis at a tertiary hospital in Cape Town, South Africa. Methods A retrospective case review of 117 patients with optic neuritis between January 2002 and December 2012. Demographic information, clinical presentation, course of illness, investigations performed and visual outcomes at discharge and at three month follow up were collected for analysis. Results 60 of 117 patients (51%) had an identifiable secondary cause for optic neuritis. Of the 57 patients with idiopathic optic neuritis, 14 had features associated with demyelinating disease. HIV and syphilis accounted for 62% of secondary causes of optic neuritis. Presenting visual acuity of hand movements (HM) or worse and absence of pain with extra ocular movement were associated with poorer final visual outcomes in the idiopathic optic neuritis group. Conclusion Optic neuritis in our patients, as elsewhere in Africa, tends to be atypical in presentation. A high proportion of patients have an identifiable secondary cause. These patients thus require more extensive investigation in order to identify causes which may influence management. Secondary optic neuritis and idiopathic atypical optic neuritis carry a poorer prognosis than typical demyelinating optic neuritis.