Acute onset blindness: a case of optic neuritis and review of childhood optic neuritis

Abstract

Optic neuritis (ON) is an acquired disorder of the optic nerve due to inflammation, demyelination or degeneration. We report a child who presented with acute onset bilateral visual loss who, following a diagnosis of ON, was treated and had excellent visual recovery. Paediatric ON is considered to be different clinical entity to adult ON. Although in children ON is usually parainfectious or postinfectious, it can be the first presenting feature of multiple sclerosis or neuromyelitis optica spectrum disease. In this paper, we discuss the literature on treatment of ON and prediction of risk of recurrence.

Figure 1

Sample of patient's handwriting showing deterioration over 3 days.

Figure 2

Right and left retinal photographs of posterior pole of the eye, 2 days after presentation. The optic disc is central in the image. There is mild disc swelling and loss of the clear disc margins with softening of the edges.

Figure 3

(A and B) Goldmann visual fields in the acute phase showing enlarged blind spot plus constriction in both eyes. The green isopter is III4e, and the purple is V4e.

Figure 4

MRI brain with gadolinium showing bilateral postcontrast enhancement of optic nerves.

Figure 5

(A and B) Normal goldmann visual fields in both eyes at 18 months follow-up. The blue isopter is I4e, and the red is I2e. The red is the smaller of the two targets.