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13.6 Painful optic neuritis

Previously used term:

Retrobulbar neuritis.


Pain behind one or both eyes caused by demyelination of the optic nerve(s) and accompanied by impairment of central vision.

Diagnostic criteria:
  1. Unilateral or bilateral retro-orbital, orbital, frontal and/or temporal pain fulfilling criterion C
  2. Clinical, electrophysiological, imaging and/or laboratory evidence confirming optic neuritis1
  3. Evidence of causation demonstrated by both of the following:
    1. pain has developed in temporal relation to the optic neuritis
    2. pain is aggravated by eye movement
  4. Not better accounted for by another ICHD-3 diagnosis.

Gadolinium-enhanced MRI shows optic nerve enhancement in 90% of cases of 13.6 Painful optic neuritis.


Clinical series report the prevalence of pain in optic neuritis to be about 90%. Pain may precede impairment of vision.

13.6 Painful optic neuritis is often a manifestation of multiple sclerosis.