eMedicine Specialties > Ophthalmology > Optic Nerve

Optic Neuritis, Childhood: Follow-up

Author: John E Carter, MD, Associate Professor, Department of Medicine, Assistant Professor, Department of Ophthalmology, University of Texas Health Science Center at San Antonio
Contributor Information and Disclosures

Updated: Aug 29, 2008

Follow-up

Further Outpatient Care

  • Outpatient follow-up care should include monitoring both visual recovery and recovery from neurologic or systemic disorders that were associated with optic neuritis.
  • Children who do develop MS may be more likely to develop disability at a younger age. Monitoring patients who had no associated neurologic signs or symptoms at the time of their optic neuritis will allow early diagnosis. Treatment of those patients for early onset MS with the disease modifying agents that are used in adults may be an option.
  • Recurrence of optic neuritis during or shortly after the discontinuation of steroids indicates a steroid-dependent optic neuritis and requires reevaluation and a more prolonged taper of corticosteroids.

Prognosis

  • The prognosis for visual recovery generally is considered excellent (see Medical Care).
  • Multiple sclerosis
    • Adults with isolated optic neuritis have a substantial risk of developing MS. Approximately 15% of patients with normal MRIs at the time of their optic neuritis develop MS in the next 4 years. However, MRI findings are strongly correlated with risk of recurrence of demyelinating events, and 50% of patients whose MRIs demonstrate white matter lesions characteristic of MS at the time of their optic neuritis develop clinically definite MS in the next 4 years.
    • Children with optic neuritis are less likely than adults to develop MS, but the risk is still present. A large study from the Mayo Clinic with a mean follow-up of 20 years produced a life-table analysis showing 13% of children with optic neuritis had progressed to clinically or laboratory-supported definite MS at 10 years (see Table 3 below). As in adult studies, those patients converting to MS were more likely to do so early; however, the longer the follow-up interval, the more patients there were who developed MS.
    • A smaller study by Wilejto et al found that 36% of children with optic neuritis developed MS.1 All who did had abnormalities on the initial MRI, and bilateral cases were more likely to go on to develop MS.

Table 3. Life-Table Analysis of the Risk for Development of MS in Children With an Isolated Attack of Optic Neuritis2

Open table in new window

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Table
AgeRisk for Development of MS
10 years13%
20 years19%
30 years22%
40 years26%
AgeRisk for Development of MS
10 years13%
20 years19%
30 years22%
40 years26%
    • MRI abnormalities in children are associated with the likelihood of developing MS.
    • Both adults and children with more severe optic disc swelling are less likely to develop MS, and those with both severe optic disc swelling and retinal exudates rarely develop MS.

Patient Education

  • With Uhthoff symptom, patients who have had demyelinating lesions with recovery often have symptoms return with exercise, exposure to heat (eg, hot baths), or febrile illnesses; a rapid return to baseline occurs when body temperature returns to normal. Warning patients about Uhthoff symptom is important so that they do not think they are having a recurrence.
  • For excellent patient education resources, visit eMedicine's Muscle Disorders Center. Also, see eMedicine's patient education article, Multiple Sclerosis.

Miscellaneous

Medicolegal Pitfalls

  • Children with optic neuritis need to be evaluated by both an ophthalmologist and a neurologist. Failure to diagnose and treat patients with optic neuritis who have additional CNS involvement could be a potential source of liability. Efforts to identify those patients who are at high risk of developing future episodes of demyelination and MS are motivated by the belief that early treatment with immunomodulator therapy is important. Although currently less of an issue with children, such decisions are in the purview of the pediatric neurologist who will be aware of the latest literature and treatment practices.
 


More on Optic Neuritis, Childhood

Overview: Optic Neuritis, Childhood
Differential Diagnoses & Workup: Optic Neuritis, Childhood
Treatment & Medication: Optic Neuritis, Childhood
Follow-up: Optic Neuritis, Childhood
Multimedia: Optic Neuritis, Childhood
References
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References

  1. Wilejto M, Shroff M, Buncic JR, et al. The clinical features, MRI findings, and outcome of optic neuritis in children. Neurology. Jul 25 2006;67(2):258-62. [Medline].

  2. Lucchinetti CF, Kiers L, O'Duffy A, et al. Risk factors for developing multiple sclerosis after childhood optic neuritis. Neurology. Nov 1997;49(5):1413-8. [Medline].

  3. Banwell B, Tremlett H. Coming of age: the use of immunomodulatory therapy in children with multiple sclerosis. Neurology. Mar 8 2005;64(5):778-9. [Medline].

  4. Beck RW. Optic neuritis. In: Miller NR, Newman NJ, ed. Walsh and Hoyt's Clinical Neuro-ophthalmology. 5th ed. Baltimore: Lippincott Williams & Wilkins; 1998.

  5. Beck RW, Trobe JD. What we have learned from the Optic Neuritis Treatment Trial. Ophthalmology. Oct 1995;102(10):1504-8. [Medline].

  6. Bonhomme GR, Liu GT, Balcer LJ. Isolated pediatric optic neuritis. Brain MRI abnormalities and risk of multiple sclerosis. Paper presented at: Annual Meeting of the North American Neuro-ophthalmology Society; 2005.

  7. Carroll DM, Franklin RM. Leber's idiopathic stellate retinopathy. Am J Ophthalmol. Jan 1982;93(1):96-101. [Medline].

  8. Dreyer RF, Hopen G, Gass JD, et al. Leber's idiopathic stellate neuroretinitis. Arch Ophthalmol. Aug 1984;102(8):1140-5. [Medline].

  9. Farris BK, Pickard DJ. Bilateral postinfectious optic neuritis and intravenous steroid therapy in children. Ophthalmology. Mar 1990;97(3):339-45. [Medline].

  10. Gass JD. Diseases of the optic nerve that may simulate macular disease. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. Sep-Oct 1977;83(5):763-70. [Medline].

  11. Hierons R, Lyle TK. Bilateral retrobulbar optic neuritis. Brain. 1959;82:56-67.

  12. Keast-Butler J, Taylor D. Optic neuropathies in children. Trans Ophthalmol Soc U K. Apr 1980;100:111-8. [Medline].

  13. Kennedy C, Carroll FD. Optic neuritis in children. Arch Ophthalmol. 1960;73:747-755.

  14. King MH, Cartwright MJ, Carney MD. Leber's idiopathic stellate neuroretinitis. Ann Ophthalmol. Feb 1991;23(2):58-60. [Medline].

  15. Koraszewska-Matuszewska B, Samochowiec-Donocik E, Rynkiewicz E. [Optic neuritis in children and adolescents]. Klin Oczna. Jun 1995;97(6):207-10. [Medline].

  16. Kriss A, Francis DA, Cuendet F, et al. Recovery after optic neuritis in childhood. J Neurol Neurosurg Psychiatry. Oct 1988;51(10):1253-8. [Medline].

  17. Maitland CG, Miller NR. Neuroretinitis. Arch Ophthalmol. Aug 1984;102(8):1146-50. [Medline].

  18. Meadows SP. Doyne memorial lecture (1969). Retrobulbar and optic neuritis in childhood and adolescence. Trans Ophthalmol Soc U K. 1970;89:603-38. [Medline].

  19. Morales DS, Siatkowski RM, Howard CW, et al. Optic neuritis in children. J Pediatr Ophthalmol Strabismus. Sep-Oct 2000;37(5):254-9. [Medline].

  20. Nakao Y, Omoto T, Shimomura Y. Optic neuritis in children. Folia Ophthalmol Jpn. 1983;34:496-498.

  21. Neetens A, Smets RM. Leber's neurogenic stellate maculopathy. Neuro Ophthalmol. 1987;7:315-328.

  22. Pohl D, Rostasy K, Gartner J, et al. Treatment of early onset multiple sclerosis with subcutaneous interferon beta-1a. Neurology. Mar 8 2005;64(5):888-90. [Medline].

  23. Riikonen R, Donner M, Erkkilä H. Optic neuritis in children and its relationship to multiple sclerosis: a clinical study of 21 children. Dev Med Child Neurol. Jun 1988;30(3):349-59. [Medline].

  24. Rothermel H, Hedges TR 3rd, Steere AC. Optic neuropathy in children with Lyme disease. Pediatrics. Aug 2001;108(2):477-81. [Medline].

  25. Rush JA. Idiopathic optic neuritis of childhood. J Pediatr Ophthalmol Strabismus. May-Jun 1981;18(3):39-41. [Medline].

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Further Reading

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Keywords

childhood optic neuritis, optic neuritis, optic nerve inflammation, optic nerve, acute vision loss, papillitis, retrobulbar optic neuritis, bilateral simultaneous optic neuritis, bilateral sequential optic neuritis, neuroretinitis, multiple sclerosis, MS, acute disseminated encephalomyelitis, neuromyelitis optica, Devic disease

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Contributor Information and Disclosures

Author

John E Carter, MD, Associate Professor, Department of Medicine, Assistant Professor, Department of Ophthalmology, University of Texas Health Science Center at San Antonio
John E Carter, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Ophthalmology, and North American Neuro-Ophthalmology Society
Disclosure: Nothing to disclose.

Medical Editor

Gerhard W Cibis, MD, Clinical Professor, Director of Pediatric Ophthalmology Service, Department of Ophthalmology, University of Kansas, Kansas City
Gerhard W Cibis, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Ophthalmological Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Brian R Younge, MD, Professor of Ophthalmology, Mayo Clinic School of Medicine
Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society
Disclosure: Nothing to disclose.

CME Editor

Ralph Garzia, OD, Assistant Dean for Clinical Programs, Associate Professor, School of Optometry, University of Missouri at St Louis
Ralph Garzia, OD is a member of the following medical societies: American Academy of Optometry and American Optometric Association
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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