October 1987

Does Neuroretinitis Rule Out Multiple Sclerosis?

Author Affiliations

From the Ophthalmology Service, Department of Surgery (Dr Parmley), and the Neurology Service, Department of Medicine (Dr Schiffman), Letterman Army Medical Center, Presidio of San Francisco; the Tallahassee Neurology Clinic and the Department of Neurology, University of Florida, Gainesville (Dr Maitland); the Neuroophthalmology Unit, The Wilmer Ophthalmological Institute, the Johns Hopkins Medical Institutions, Baltimore (Dr Miller); the Department of Ophthalmology, University of Iowa Medical Center, Iowa City (Dr Dreyer); the Division of Neuro-ophthalmology, Department of Neurosurgery, University of California Medical Center, San Francisco (Dr Hoyt).

Arch Neurol. 1987;44(10):1045-1048. doi:10.1001/archneur.1987.00520220047015

• Neuroretinitis, a form of optic neuritis, is characterized by papillitis and a stellate macular exudate, or "macular star." The star implies the presence of a disc vasculopathy and secondary leakage of lipoproteinaceous material into the macula. Demyelinating optic neuritis would not be expected to produce a secondary macular exudate. We reviewed the literature on the risk of multiple sclerosis developing in a patient after an attack of optic neuritis, and rarely found a comment on the presence of a macular star. We then reviewed two series of 40 patients who had neuroretinitis and added ten patients of our own. Signs of multiple sclerosis had not developed in the 13 patients contacted retrospectively, nor in the patients followed up prospectively. We also noted that in our patients, neuroretinitis may be accompanied by other neurologic manifestations; neuroretinitis may be bilateral and may be staggered; papillitis may present without a macular star, only to have typical exudates develop up to two weeks later; and the macular exudate may take up to 12 months to resolve. We suggest that patients who demonstrate acute papillitis with a normal macula be reevaluated within two weeks for the development of a macular star. Its presence militates strongly against the subsequent development of multiple sclerosis.