Approach to the Critical Patient

Immediate priorities

Vision-threatening emergencies

Stabilization and escalation

Escalation triggers

Monitoring targets

Visual function monitoring

Key consults

Consultation triggers

History

Onset and progression

Core symptom timeline

Associated neurologic symptoms

Demyelinating symptom screen

Alarm history features

Atypical pattern red flags

Risk factors and background

Demographic risk profile

Medical and exposure history

Functional impact

Vision-related functional history

Physical Exam

Visual function assessment

Acuity and pupils

Fundoscopic exam

Optic disc findings

Neurologic exam

Systemic neurologic assessment

Vascular and GCA exam

Giant cell arteritis screen

Differential Diagnosis

Life-threatening and vision-threatening causes

Must-not-miss diagnoses

Demyelinating subtypes

Optic neuritis spectrum

Non-inflammatory mimics

Ischemic and vascular

Genetic and toxic

Inflammatory non-demyelinating

Laboratory Tests

Core serologic workup

Antibody panel — all atypical or severe cases

Inflammatory markers

Extended workup when indicated

Autoimmune panel

Thyroid function

CSF analysis

Lumbar puncture — when diagnostic uncertainty persists

Diagnostic Tests

Scoring Systems

MS risk stratification tools

MRI

MRI brain and orbits with gadolinium — first-line imaging

MRI spine

CT

CT limitations in optic neuritis

Ultrasound

Orbital ultrasound (B-scan and optic nerve sheath diameter)

Additional special tests

Visual evoked potentials (VEPs)

Optical coherence tomography (OCT)

Disposition

Admission indications

Inpatient admission criteria

Outpatient infusion or observation

Infusion center approach for typical ON

Discharge criteria and follow-up

Criteria for discharge

Follow-up timing

Treatment

Acute corticosteroid therapy

High-dose corticosteroids — first-line acute treatment

Steroid cautions

Steroid-refractory treatment

Plasma exchange (PLEX)

IVIG — alternative when PLEX unavailable

Atypical ON — extended steroid protocol

NMOSD and MOGAD acute regimen

Long-term disease-modifying therapy

MS — disease-modifying therapy (DMT) initiation

NMOSD — maintenance immunosuppression

MOGAD — relapse prevention

Supportive and symptomatic treatment

Pain management

Uhthoff phenomenon counseling

Special Populations

Pregnancy

Pregnancy considerations for optic neuritis

Geriatric

Older adult considerations

Pediatrics

Pediatric optic neuritis features

Background

Epidemiology

Frequency and demographics

Pathophysiology

Mechanisms of optic nerve injury

Lesion location subtypes

Therapeutic Considerations

Corticosteroid principles

Subtype differentiation imperative

Neuroprotection and visual recovery

Patient Discharge Instructions

copy discharge instructions

Optic neuritis home care

Warning signs — return to ER immediately

Follow-up appointments

MS risk counseling

References

Guidelines and key sources

Landmark trials

Society guidelines and criteria

Key review articles

Coding standards

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.