Optic neuritis in pediatric population: a review in current tendencies of diagnosis and management

Abstract

Optic neuritis is an inflammation of the optic nerve and may be related to different systemic conditions. The clinical presentation of this pathology usually includes sudden loss of visual acuity (VA) which may be unilateral or bilateral, visual field restriction, pain with eye movements, dyschromatopsia, a relative afferent pupillary defect and optic disk swelling. Optic neuritis in children has specific clinical features and a better prognosis than in adulthood. Although usually appears an underlying viral disease, the main concern for practitioners is the relationship of optic neuritis with multiple sclerosis. In addition to the classical techniques as magnetic resonance imaging (MRI), current tendencies of diagnosis for eye practitioners include new imaging devices as optical coherence tomography (OCT), useful to show a thinning of the retinal fibers layer (RFL) after the inflammatory episode. Regarding the management of these patients, short-term intravenous steroid dosages seem to be the best option to treat acute attacks characterized by a very poor bilateral VA.

Keywords: Childhood; Esclerosis múltiple; Infancia; Multiple sclerosis; Neuritis óptica; Optic neuritis; Optical coherence tomography; Tomografía de coherencia óptica.

Figure 1

Optic disk temporal pallor after an episode of bilateral optic neuritis in a 13 years-old patient with a VA of 0.2 (decimal scale).

Figure 2

Papillary optical coherence tomography showing a retinal fibers layer thinning in a 13 years-old patient after an acute episode of bilateral optic neuritis.