{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T11:27:28Z","timestamp":1786620448321,"version":"build-2736575974"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:p>Infectious optic neuropathy (ION) represents a major clinical challenge at the intersection of ophthalmology and neurology. Its pathogenesis typically involves a complex interplay between direct pathogen invasion and post-infectious immune-mediated injury. Current clinical management faces two core challenges: (1) accurately differentiating direct pathogen-induced injury from post-infectious autoimmune optic neuritis [e.g., myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)]; and (2) avoiding exacerbation or dissemination of occult infection when immunosuppressive therapy is required. Traditional static classification models based on pathogen profiles are insufficient to guide dynamic clinical decision-making and may lead to delayed treatment or overtreatment. In this review, we propose a dynamic decision-making framework grounded in pathophysiological mechanisms. We summarize practical clinical clues for distinguishing these two injury patterns, outline key considerations for systemic corticosteroid use, and discuss the positioning of emerging diagnostic technologies\u2014such as metagenomic next-generation sequencing (mNGS)\u2014within current clinical pathways. Drawing on available clinical evidence, we advocate an individualized intervention strategy centered on \u201cdynamic balance,\u201d emphasizing that decisions should be guided by the predominant mechanism at each disease stage rather than a rigid dichotomy between \u201cinfectious versus non-infectious.\u201d Finally, we highlight key evidence gaps and underscore that this mechanism-informed framework is a pragmatic synthesis that requires prospective validation.<\/jats:p>","DOI":"10.3389\/fcimb.2026.1896851","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T10:29:30Z","timestamp":1786616970000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Infectious optic neuropathy: the interplay between pathogens and the host immune system\u2014a review of diagnostic and therapeutic dilemmas"],"prefix":"10.3389","volume":"16","author":[{"given":"Yin","family":"Jiang","sequence":"first","affiliation":[{"name":"Anqing Municipal Hospital","place":["Anqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Si","sequence":"additional","affiliation":[{"name":"Anqing Municipal Hospital","place":["Anqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Chen","sequence":"additional","affiliation":[{"name":"Anqing Shihanbin Aier Eye Hospital","place":["Anqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bei","family":"Chen","sequence":"additional","affiliation":[{"name":"Anqing Municipal Hospital","place":["Anqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Long","sequence":"additional","affiliation":[{"name":"Anqing Municipal Hospital","place":["Anqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Jiang","sequence":"additional","affiliation":[{"name":"Anqing Municipal Hospital","place":["Anqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shangang","family":"Pan","sequence":"additional","affiliation":[{"name":"Anqing Municipal Hospital","place":["Anqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueqin","family":"Chu","sequence":"additional","affiliation":[{"name":"Anqing Municipal Hospital","place":["Anqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanming","family":"Tian","sequence":"additional","affiliation":[{"name":"Southwest Medical University Affiliated Tianfu Hospital","place":["Meishan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huarong","family":"Wu","sequence":"additional","affiliation":[{"name":"Anqing Municipal Hospital","place":["Anqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"B13","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1080\/09273948.2024.2325054","article-title":"Cytomegalovirus-associated non-necrotizing retinopathy, occlusive retinal vasculitis, and neovascularization","volume":"32","author":"Alcibahy","year":"2024","journal-title":"Ocul. 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