Pediatric
optic neuritis is a rare disorder causing a subacute loss of vision (often bilateral) in children, often of a severe degree. Common clinical findings include dense visual field loss,
afferent pupillary defect (APD) in unilateral cases, and
papillitis that is often bilateral. Contrary to
optic neuritis in the adult population, the differential diagnosis for this disorder in pediatric patients is quite extensive, so neuroimaging and serologic evaluation are necessary to exclude an infectious or neoplastic process. Pediatric
optic neuritis may occur as a clinically isolated syndrome, or in association with diffuse
neurologic dysfunction, such as
acute disseminated encephalomyelitis (ADEM).
Optic neuritis may also be the first episode heralding the onset of pediatric
multiple sclerosis or
neuromyelitis optica (NMO or
Devic's disease). Therefore, formal neurologic evaluation and follow-up are indicated. Although the management of this disorder in adults is well described, there is a paucity of evidence-based, prospective clinical data on its management and treatment in a pediatric population. The current treatment of pediatric
optic neuritis consists of 3 to 5 days of intravenous
methylprednisolone (4-30 mg/kg per day), followed by a prolonged oral
corticosteroid taper. A prolonged course of oral
steroid (2-4 weeks) is recommended to avoid recurrence, which is common in this age group. Some controversy persists concerning the exposure of children to high-dose parenteral
corticosteroids to treat an entity that is usually self-limited, but given the severity of vision loss in one or both eyes in this population, this intervention is standard in neuro-ophthalmologic practice.