What are the recommended management strategies for a patient diagnosed with optic neuritis, including the use of corticosteroids?

Management strategies for optic neuritis primarily involve corticosteroid treatment to hasten visual recovery, although they do not affect the long-term visual outcome. High-dose intravenous methylprednisolone (e.g., 1 g daily for 3 to 5 days) is commonly used, especially in severe cases or when hospital admission is required. Oral corticosteroids such as methylprednisolone 0.5 g daily for 5 days may be considered in less severe cases or as an alternative if intravenous therapy is not feasible. The use of corticosteroids should be discussed with a specialist, particularly a neurologist or ophthalmologist, to confirm diagnosis and tailor treatment, as not all cases require steroids and underlying causes such as multiple sclerosis (MS) should be considered.

Before initiating corticosteroids, active infections should be ruled out or treated, as steroids can exacerbate infections. Patients should be informed about the benefits and risks of high-dose steroids, including potential side effects such as mood changes, insomnia, and blood glucose alterations. Follow-up with specialist teams is important to monitor response and consider further management, including disease-modifying therapies if MS is diagnosed.

Referral to ophthalmology is essential for diagnosis confirmation and to exclude other causes of visual loss. Urgent referral is indicated if there is severe or worsening visual impairment.