Table 1

Key differences between optic neuritis and optic perineuritis

FeaturesOptic perineuritisOptic neuritis
Onset of visual lossSubacute (over weeks)Acute (days)
PathologyOptic nerve sheath inflammationOptic nerve inflammation
Visual field defectUsually paracentral scotoma/ arcuate defectCentral scotoma
Association with multiple sclerosisNoYes
SignsLess dyschromatopsia. Subtler RAPDMore
Usually substantial RAPD
Diagnosis: MRI findingsPerineural enhancement (‘tram-track’ sign on axial view and ‘doughnut sign’ on coronal view)
Fat streakiness may also be present
Intraneural enhancement
TreatmentOral corticosteroidsIntravenous methylprednisolone followed by oral steroids
Response to corticosteroidsVision improves dramaticallySteroids may speed the recovery but do not affect the final visual outcome
Relapse with steroids therapyRisk of relapse increases if the duration of treatment is inadequateHigh risk of relapse with oral steroids if used alone
PrognosisProgressive deterioration of vision without treatment with steroidsRecovers spontaneously, even without steroid therapy
  • RAPD, relative afferent pupillary defect.