Optic Neuritis in Children: Case Series of Differing Treatment and Literature Review

Abstract

Introduction: Optic neuritis is an inflammatory condition that can cause significant vision loss. Treatment is challenging due to its rarity and the complications of long-term steroid use. Paediatric treatment options are less well-defined compared to those for adults, as current protocols primarily derive from the adult-focused Optic Neuritis Treatment Trial (ONTT), which limits their overall applicability in paediatric care and outcomes. Case series: This case series reports on the treatment approaches and outcomes for bilateral optic neuritis in four children, all of whom were female. In the first case, no oral steroid taper was given following intravenous infusion. In contrast, the second and third cases were treated with intravenous infusion of different durations, followed by a tapering regimen lasting four weeks. No steroids were administered in the fourth case. Among the children who received steroids, visual outcomes ranged from 6/9 to 6/6, although the timing of recovery varied. The child who did not receive steroids had a slightly reduced visual acuity of 6/12 in one eye. These cases highlight the importance of considering various factors, including age, visual outcomes, recovery duration, medication side effects, relapse probability, and individual patient needs, when selecting the most appropriate corticosteroid treatment strategy. Conclusion: Early clinical recognition of optic neuritis, followed by prompt treatment, is warranted for all age groups. Tailoring treatment to individual needs is crucial for achieving the best outcomes with minimal side effects. There is a need for more paediatric-focused trials to guide clinicians in developing optimal treatment protocols for children with optic neuritis.