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Optic Neuritis

What is optic neuritis?

Optic neuritis is a condition that involves inflammation of the optic nerve [See figure 1]. The optic nerve carries the visual signal from the eye to the brain.

What are the symptoms of optic neuritis?

The first symptom of optic neuritis in a child is most commonly a rapid, often profound decrease in vision (visual acuity less than 20/400) in both eyes, sometimes worse in one eye than the other. Headache and pain with eye movement may be associated. Many children with optic neuritis have a history of a fever, flu-like illness, or immunizations 1-2 weeks prior to the onset of the decreased vision.

What causes optic neuritis?

Optic neuritis is thought to be an autoimmune disorder, in which the immune system mistakenly attacks optic nerve tissue. The attack of the immune system causes inflammation, swelling and impaired function of the optic nerve.

How is optic neuritis diagnosed?

A careful history including inquiring about recent illness with fever or recent immunizations is helpful. The Eye MD checks vision (which is usually markedly decreased) and evaluates optic nerve function including the pupil reactions, color vision, and peripheral vision. The Eye MD also examines the optic nerve with ophthalmoscopy for inflammation and swelling .Other tests performed may include an MRI, a spinal tap (lumbar puncture), and blood tests.

Fig. 1 Optic nerve swelling in a patient with optic neuritis.

What is the prognosis and treatment for optic neuritis?

Fortunately, most children with optic neuritis recover much of their vision. This usually occurs spontaneously and treatment may not be necessary. Recovery usually begins within a few weeks, and can continue for several months. Intravenous corticosteroids may speed the recovery of vision, but probably do not improve the final visual outcome. Unfortunately, a small percentage of children do not recover vision.

What are the differences between optic neuritis in children and adults?

Both eyes are usually affected in children, while adults usually have only one eye affected. Children with optic neuritis usually have a history of recent illness or immunization and adults do not. Lastly, adults with optic neuritis have an increased risk of developing multiple sclerosis, while children have a much lower isk.