Optic neuritis in children: Clinical features and visual outcome

Background: The purpose of this paper is to study the clinical spectrum of pediatric optic neuritis. We evaluated the presenting features, neuroimagin g findings, cerebrospinal fluid abnormalities, associated systemic disease, and visual outcome in patients with this condition. Methods: A retrospecti ve analysis was performed on all patients who came to Baylor College of Med icine with optic neuritis during a B-year period from 1991 to 1997. The deg ree of initial visual loss, subsequent visual recovery, and associated dise ase were reviewed. Magnetic resonance images and cerebrospinal fluid findin gs were also analyzed. Results:Twenty-five patients (39 eyes) 21 months of age to 18 years of age were included in the study, with a mean follow-up of 11 months. Fourteen patients (56%) had bilateral optic neuritis, and 11 pa tients (44%) had unilateral disease. Thirty-three of 39 eyes (84%) had visu al acuity of 20/200 or less at presentation. Twenty-one of 25 patients (84% ) were given intravenous methylprednisolone (10 to 30 mg/kg/day). Thirty of 39 eyes (76%) recovered 20/40 visual acuity or better. Three of 39 eyes (7 %) recovered vision in the 20/50 to 20/100 range. Six of 39 eyes (15%) reco vered vision of 20/200 or less. Twenty-three of 25 patients (92%) underwent magnetic resonance imaging of the brain. A normal magnetic resonance image of the brain was associated with recovery of 20/40 or better visual acuity in 6 of 6 affected eyes (100%). Seven patients were 6 years of age or youn ger at presentation. Six of 7 (85%)had bilateral disease, and 12 of 13 (92% ) affected eyes recovered 20/40 visual acuity or better. Eighteen patients were 7 years of age or older at presentation. Eight of 18 (44%) had bilater al disease, and 10 of 18 patients (56%) had unilateral disease. Eighteen of 26 affected eyes (50%) recovered 20/40 visual acuity or better. Conclusion : Pediatric optic neuritis is usually associated with visual recovery; howe ver, a significant number (22%) remain visually disabled. A normal magnetic resonance image of the brain may be associated with a better outcome. Youn ger patients are more likely to have bilateral disease and a better visual prognosis.