Optic neuritis in children

Purpose: To describe the clinical characteristics of optic neuritis in chil dren, including final visual acuity and development of multiple sclerosis ( MS). Methods: Charts were reviewed of all patients <15 years of age who presente d with optic neuritis to the Bascom Palmer Eye Institute or the Miami Child ren's Hospital between 1986 and 1998. Results: Fifteen patients were identified. There was a slight female predil ection in the study group (60%), with a mean age of 9.8 years at presentati on. A preceding febrile illness within 2 weeks of visual symptoms was repor ted in 66% of patients. Initial visual acuity ranged from 20/15 to no light perception. Involvement was bilateral in 66% of patients, and disc swellin g was present in 64% of involved eyes. Of the patients who underwent magnetic resonance imaging, 33% had focal dem yelinating lesions in the brain, and 63% of affected nerves were enlarged o r enhanced with gadolinium. Eleven patients were treated with intravenous s teroids. Final visual acuity was greater than or equal to 20/40 in 58.3% of eyes. Thirty percent of the patients had vision of finger counting or wors e. Four (26%) patients developed MS. The mean age of patients with MS was 1 2 years, compared with 9 years in children who did not develop MS. Patients with unilateral involvement had an excellent visual prognosis (100% >20/40 ), but a higher rate of development of MS (75%). Two patients had positive serology for Lyme disease. Conclusions: Optic neuritis presents differently in children than in adults . Children typically have bilateral involvement with papillitis following a n antecedent viral illness. Although visual prognosis is poorer in children than adults, the development of MS is less common in children. Children wh o present with unilateral involvement have a better visual prognosis; howev er, they also develop MS at a greater frequency than children with bilatera l involvement. Patients who developed MS were, an average, older at present ation with optic neuritis than those who did not develop MS.