There is no study on whether intra-vitreal steroids can improve the optic neuritis patients’ final visual acuity. In fact, oral/ intravenous steroids can only fasten the visual recovery, cannot improve the final visual acuity. Thus, the patients have to face the risk of complications by intra-vitreal injection if they were managed by this manner. Even retrobulbar injection was not recommended by Neuro-ophthalmologist because of its complications. If you need to manage an optic neuritis patient, I recommend treating him/her with intravenous methylprednisolone pulse.

giving intravitreal steroids for optic neuritis poses more risks than benefits as compared to giving it IV/orally, such as: endophthalmitis, incorrect plane of penetration (hit the lens, retinal detachment, choroidal detachment), the steroids may spread in and around the globe causing a rise in intraocular or even orbital (if the steroids spread and occupy the orbital fat spaces) pressure, in the case of the latter, it may lead to ischemia. Hence, intravit steroid injection as treatment route for typical optic neuritis (demyelinating) is not advocated as the risks are higher than the benefit.

for typical optic neuritis, the iv route has long been proven to hasten visual recovery and it is also a relatively safe method to use so there is not much need to use a route, like intravitreal, which poses more risks for the patient.

Agree that risks outweigh benefits. Have not seen anyone do intravit steroids for an optic neuritis.