Acute optic neuritis in children: clinical features and treatment. A studyof 20 cases (28 eyes)

Purpose: Analyzing a personal series of children with acute optic neuritis (AON), we studied: 1) etiology, 2) the risk of progression to multiple scle rosis, 3) the therapeutical management of the onset. Material and methods: A retrospective study of 28 eyes in 20 patients (mean age: 10;7 years), examined between 1982 and 1997, with a follow-up ranging from 6 months to 15 years (mean: 5;5 years). We recorded etiologic factors , clinical features (ocular and extra ocular), biological results, and neur oimaging findings. Results: Initial involvement was uni- or bilateral with poor visual acuity (under 20/200 in 22 eyes of 28). Intracerebral inflammation was present in 9 of 13 cases where MRI was performed. We found a cause in only 7 cases (5 viral diseases and 2 recent vaccinations against hepatitis B). Visual recov ery was good lover 20/25 in 20 eyes of 28) whatever the treatment, but AON recurred in 5 children. Four children later developed multiple sclerosis. Conclusions: The cause of AON is rarely found. After eliminating an infecti on, we retained viral disease, complication of a recent vaccination against hepatitis B, and neurological diseases. MRI was the imaging study of choic e. Development of multiple sclerosis occurred in 4 cases of 20, the same fr equency as in the literature. The risk of later development of multiple scl erosis was 20%. Progression of AON was often excellent. Nevertheless, corti cotherapy was added, in form of intravenous boluses followed by decreasing oral therapy for one month.