Pediatric optic neuritis (ON)

What is pediatric optic neuritis (ON)?

The optic nerve is made up of a collection of neurons that carries visual information from each eye to the brain. When these nerves become inflamed, it’s called optic neuritis.

Optic neuritis affects between 1 and 5 people out of 100,000. It can affect children and adults of all ages. Most children respond well to treatment and don’t have long-term problems with vision or eye pain.

What are the signs and symptoms of pediatric optic neuritis (ON)?

Children with optic neuritis (ON) typically experience eye pain. The pain is often worse when they move their eyes. If the condition isn’t treated, a child may suffer partial or complete loss of vision. Symptoms can occur in one or both eyes.

How is pediatric optic neuritis (ON) diagnosed?

We diagnose optic neuritis with tests that look at different aspects of your child’s eye and brain function. This includes testing your child’s vision and getting different images of the eye.

• Optical coherence tomography (OCT) - Children’s Health is one of the only pediatric neurology clinics in the country to offer a test called optical coherence tomography (OCT) within the clinic. This quick, non-invasive test gives an extremely detailed picture of the retina and the cells that make up the optic nerve, to help us look for inflammation and scarring. Patients at other clinics usually have to go to a separate eye doctor to get this test.

• Magnetic resonance imaging (MRI) - An MRI can be used to confirm evidence of inflammation within the optic nerve. Since multiple conditions that cause optic neuritis can affect the brain or spine as well, we perform additional MRIs and other tests to get a full picture of your child’s condition and how to treat it.

• Lab work - We also request blood tests to help identify what is causing your child’s optic neuritis (ON).

What causes pediatric optic neuritis (ON)?

Optic neuritis (ON) happens as a result of another health condition, such as a disease or infection.

Common causes include autoimmune diseases like:

• Multiple sclerosis (MS)

• Neuromyelitis optica spectrum disorder

• Anti-MOG associated disorder

With this type of disease, the immune system doesn’t work properly and attacks healthy cells. When this happens to cells on the optic nerve, it causes inflammation that causes the symptoms of optic neuritis.

How is pediatric optic neuritis (ON) treated?

• Medication - The first step in treating optic neuritis is to reduce the inflammation. We will give your child steroids, either as a pill or as an infusion.

• Plasmapheresis (plasma exchange or PLEX) - If the inflammation is severe or doesn’t go away after treatment, we do a process called plasmapheresis (also called plasma exchange or PLEX). This involves connecting your child to a machine that removes certain immune proteins from their blood, to reduce inflammation within the optic nerve.

From there, we treat the condition that’s causing your child’s optic neuritis. If it’s an infection, we may prescribe antibiotics. If it’s an autoimmune disease like multiple sclerosis, your child may require medicine that prevent future damage from their immune system.