Medication Summary
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Corticosteroids
Class Summary
A widely used group of drugs. They have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli. GI tract absorption is approximately 85% of intravenously administered doses. Corticosteroids are well tolerated. A brief course of steroids is not expected to produce significant adrenal complications. Many physicians prescribe an H2 blocker to prevent GI tract distress.
Methylprednisolone (Medrol, Adlone, Medralone injection)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Prednisone (Meticorten, Orasone, Deltasone, Sterapred)
May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.
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Optic disc swelling in the right eye and left eye in a child with bilateral optic neuritis.
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Neuroretinitis in the right eye of an adolescent with cat scratch disease. The optic nerve is swollen, and a deposition of yellowish exudate in the nerve fiber layer of the macula produces a macular star.
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T1 contrast enhanced axial section of an MRI of the orbital optic nerve of a child with optic neuritis on the left side. The arrows point to the left optic nerve that enhances along its entire orbital course.
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T1 contrast enhanced coronal section of the MRI of the orbital optic nerve. The arrow points to the enhancing left optic nerve.
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T1 contrast enhanced axial section of an MRI of the intracranial optic nerves. Enhancement of both optic nerves is seen. The arrow indicates the left optic nerve.
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T1 contrast enhanced coronal section of the MRI showing the optic nerves that both enhance. The arrow points to the left optic nerve.
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T2 axial section of an MRI through the cerebral hemisphere of a boy with bilateral optic neuritis. Note high-signal abnormalities in the cerebral white matter that are most prominent in the posterior hemispheres. This is suspicious for mild acute disseminated leukoencephalitis.
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T2 axial sections of MRI of a man with optic neuritis showing scattered white matter lesions. The arrows point to 2 examples of the numerous lesions.
Tables
- Table 1. Comparison of Features of Optic Neuritis in Adults and Children
- Table 2. Life-Table Analysis of the Risk for Development of MS in Children With an Isolated Attack of Optic Neuritis [9]
- Table 3. Visual Acuity on Examination in Children with Optic Neuritis
- Table 4. Equivalent Doses of Commonly Used Corticosteroid Medications
Adult Optic Neuritis |
Pediatric Optic Neuritis |
Unilateral |
Often bilateral in children < 10 years [6] |
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, with the exception of NMO |
Age |
Risk for Development of MS |
10 years |
13% |
20 years |
19% |
30 years |
22% |
40 years |
26% |
| Percentage (%) | Visual Acuity |
|---|---|
| 20 | 20/40 or better at presentation |
| 20 | 20/50 - 20/190 |
| 60 | 20/200 or worse |
Corticosteroid Drug |
Approximate Equivalent Dose |
Prednisone |
5 mg |
Prednisolone |
5 mg |
Methylprednisolone |
4 mg |
Dexamethasone |
0.75 mg |
