Childhood Optic Neuritis Treatment & Management
- Author: Martha P Schatz, MD; Chief Editor: Hampton Roy, Sr, MD more...
The prognosis for visual recovery is excellent in adults with or without medical therapy, as found in the Optic Neuritis Treatment Trial (ONTT).[3, 4]
No prospective study of the prognosis for visual recovery in children is available; most, but not all, studies of children have found that visual recovery is good. However, some authors, including those of Walsh & Hoyt's Clinical Neuro-ophthalmology, believe that a greater prevalence of steroid-responsive and steroid-dependent optic neuritis exists in children and routinely treat all their patients with high-dose corticosteroids.
In the ONTT, high-dose steroids consisted of methylprednisolone 250 mg administered intravenously every 6 hours for 3 days, followed by oral prednisone 1 mg/kg daily for 11 days.
No systematic study defining high-dose corticosteroids in childhood optic neuritis has been conducted. Walsh & Hoyt's Clinical Neuro-ophthalmology recommends methylprednisolone 1-2 mg/kg for 3-5 days, followed by a longer taper. Farris and Pickard used doses of methylprednisolone, ranging from 0.25-6.26 mg/kg, with one half of patients receiving doses of 125 mg or 250 mg every 6 hours for 5 days, followed by a taper. The author favors methylprednisolone administered intravenously.
Treatment of the initial event in neuromyelitis optica, whether it is optic neuritis or myelitis, also uses high-dose intravenous steroids, but refractory cases are common and other therapies may be needed. Currently, plasma exchange is favored in those cases, but intravenous immune globulin (IVIg) has also been used.
The equivalent doses of 4 commonly used drugs to treat optic neuritis are provided in Table 2.
Table 2. Equivalent Doses of Commonly Used Corticosteroid Medications (Open Table in a new window)
|Corticosteroid Drug||Approximate Equivalent Dose|
See related CME at Optic Neuritis: Diagnosis, Treatment, and Prognosis.
The management of a child with optic neuritis is a combined effort by the ophthalmologist and the neurologist. Ophthalmologic input is required to distinguish between optic neuritis and neuroretinitis and to monitor visual response. Neurologic input is required to evaluate possible generalized CNS involvement and to make appropriate decisions and recommendations based on the future risk of MS.
Children taking etanercept or other tumor necrosis factor (TNF) inhibitors should be reevaluated by their rheumatologists.
Dell'Avvento S, Sotgiu MA, Manca S, Sotgiu G, Sotgiu S. Epidemiology of multiple sclerosis in the pediatric population of Sardinia, Italy. Eur J Pediatr. 2015 Jul 10. [Medline].
Langer-Gould A, Zhang JL, Chung J, Yeung Y, Waubant E, Yao J. Incidence of acquired CNS demyelinating syndromes in a multiethnic cohort of children. Neurology. 2011 Sep 20. 77(12):1143-8. [Medline].
Pérez-Cambrodí RJ, Gómez-Hurtado Cubillana A, Merino-Suárez ML, Piñero-Llorens DP, Laria-Ochaita C. Optic neuritis in pediatric population: a review in current tendencies of diagnosis and management. J Optom. 2014 Jul-Sep. 7 (3):125-30. [Medline].
Wan MJ, Adebona O, Benson LA, Gorman MP, Heidary G. Visual outcomes in pediatric optic neuritis. Am J Ophthalmol. 2014 Sep. 158 (3):503-7.e2. [Medline].
Waldman AT, Stull LB, Galetta SL, Balcer LJ, Liu GT. Pediatric optic neuritis and risk of multiple sclerosis: Meta-analysis of observational studies. J AAPOS. 2011 Oct. 15(5):441-6. [Medline].
Wilejto M, Shroff M, Buncic JR, et al. The clinical features, MRI findings, and outcome of optic neuritis in children. Neurology. 2006 Jul 25. 67(2):258-62. [Medline].
Lucchinetti CF, Kiers L, O'Duffy A, et al. Risk factors for developing multiple sclerosis after childhood optic neuritis. Neurology. 1997 Nov. 49(5):1413-8. [Medline].
Banwell B, Tremlett H. Coming of age: the use of immunomodulatory therapy in children with multiple sclerosis. Neurology. 2005 Mar 8. 64(5):778-9. [Medline].
Beck RW. Optic neuritis. Miller NR, Newman NJ, ed. Walsh and Hoyt's Clinical Neuro-ophthalmology. 5th ed. Baltimore: Lippincott Williams & Wilkins; 1998.
Beck RW, Trobe JD. What we have learned from the Optic Neuritis Treatment Trial. Ophthalmology. 1995 Oct. 102(10):1504-8. [Medline].
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.
Carroll DM, Franklin RM. Leber's idiopathic stellate retinopathy. Am J Ophthalmol. 1982 Jan. 93(1):96-101. [Medline].
Dreyer RF, Hopen G, Gass JD, et al. Leber's idiopathic stellate neuroretinitis. Arch Ophthalmol. 1984 Aug. 102(8):1140-5. [Medline].
Farris BK, Pickard DJ. Bilateral postinfectious optic neuritis and intravenous steroid therapy in children. Ophthalmology. 1990 Mar. 97(3):339-45. [Medline].
Gass JD. Diseases of the optic nerve that may simulate macular disease. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1977 Sep-Oct. 83(5):763-70. [Medline].
Hierons R, Lyle TK. Bilateral retrobulbar optic neuritis. Brain. 1959. 82:56-67.
Keast-Butler J, Taylor D. Optic neuropathies in children. Trans Ophthalmol Soc U K. 1980 Apr. 100:111-8. [Medline].
Kennedy C, Carroll FD. Optic neuritis in children. Arch Ophthalmol. 1960. 73:747-755.
King MH, Cartwright MJ, Carney MD. Leber's idiopathic stellate neuroretinitis. Ann Ophthalmol. 1991 Feb. 23(2):58-60. [Medline].
Koraszewska-Matuszewska B, Samochowiec-Donocik E, Rynkiewicz E. [Optic neuritis in children and adolescents]. Klin Oczna. 1995 Jun. 97(6):207-10. [Medline].
Kriss A, Francis DA, Cuendet F, et al. Recovery after optic neuritis in childhood. J Neurol Neurosurg Psychiatry. 1988 Oct. 51(10):1253-8. [Medline].
Maitland CG, Miller NR. Neuroretinitis. Arch Ophthalmol. 1984 Aug. 102(8):1146-50. [Medline].
Meadows SP. Doyne memorial lecture (1969). Retrobulbar and optic neuritis in childhood and adolescence. Trans Ophthalmol Soc U K. 1970. 89:603-38. [Medline].
Morales DS, Siatkowski RM, Howard CW, et al. Optic neuritis in children. J Pediatr Ophthalmol Strabismus. 2000 Sep-Oct. 37(5):254-9. [Medline].
Nakao Y, Omoto T, Shimomura Y. Optic neuritis in children. Folia Ophthalmol Jpn. 1983. 34:496-498.
Neetens A, Smets RM. Leber’s neurogenic stellate maculopathy. Neuro Ophthalmol. 1987. 7:315-328.
Pohl D, Rostasy K, Gartner J, et al. Treatment of early onset multiple sclerosis with subcutaneous interferon beta-1a. Neurology. 2005 Mar 8. 64(5):888-90. [Medline].
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. 1988 Jun. 30(3):349-59. [Medline].
Rothermel H, Hedges TR 3rd, Steere AC. Optic neuropathy in children with Lyme disease. Pediatrics. 2001 Aug. 108(2):477-81. [Medline].
Rush JA. Idiopathic optic neuritis of childhood. J Pediatr Ophthalmol Strabismus. 1981 May-Jun. 18(3):39-41. [Medline].
|Adult Optic Neuritis||Pediatric Optic Neuritis|
|Retrobulbar optic neuritis||Papillitis|
|Commonly associated with pain on eye movements||Commonly associated with headache|
|Most often idiopathic||Most often postinfectious or postimmunization|
|High probability of recurrent inflammatory demyelinating events in the CNS and a diagnosis of MS||Low probability of recurrent demyelinating events and a diagnosis of MS|
|Corticosteroid Drug||Approximate Equivalent Dose|
|Age||Risk for Development of MS|