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Updated: Mar 15, 2026
Dynamic Visual Tests to Identify and Quantify Visual Damage and Repair Following Demyelination in Optic Neuritis Patients
Published on: April 14, 2014
Pediatric optic neuritis
E Ann Yeh1, Jennifer S Graves2, Leslie A Benson2
1From the Division of Neurology (E.A.Y.), Hospital for Sick Children, Hospital for Sick Children Research Institute, Department of Pediatrics, University of Toronto, Ontario, Canada; Department of Neurology (J.S.G.), University of California, San Francisco; Department of Neurology (L.A.B.), Boston Children's Hospital, Boston, MA; Department of Neurology (E.W.), Birmingham Children's Hospital, Birmingham, UK; and Department of Neurology (A.W.), The Children's Hospital of Philadelphia, PA. ann.yeh@sickkids.ca.
Insights
Pediatric optic neuritis (ON) presents differently by age, with younger children experiencing bilateral symptoms and older children unilateral. While visual acuity often recovers, some children face lasting vision impairment despite steroid treatment.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Neuroimmunology
Background:
- Optic neuritis (ON) is a frequent initial symptom of central nervous system (CNS) demyelinating disorders in children.
- ON can lead to significant visual impairment, impacting quality of life and development.
Purpose of the Study:
- To review current knowledge on the clinical presentation and management of pediatric ON.
- To highlight associated syndromes and diagnostic tools for pediatric ON.
Main Methods:
- Review of recent literature on pediatric optic neuritis.
- Analysis of clinical presentation, associated diseases, therapeutic approaches, and outcomes.
Main Results:
- Younger children (<10 years) more commonly present with bilateral ON, while older children (>10 years) typically have unilateral ON.
- Most children achieve excellent high-contrast visual acuity recovery post-ON.
- Evidence suggests irreversible structural and functional visual decline may occur despite treatment.
Conclusions:
- High-dose pulse steroids are considered safe and likely effective for pediatric ON, despite a lack of randomized controlled trials.
- Understanding age-related presentation and potential long-term effects is crucial for managing pediatric ON.
Abstract:
Optic neuritis (ON) is a common presenting symptom in pediatric CNS demyelinating disorders and may be associated with dramatic visual loss. Knowledge regarding clinical presentation, associated diseases, therapy, and outcomes in ON in children has grown over the past decade. These studies have shown that younger children (<10 years of age) are more likely to present with bilateral ON and older children with unilateral ON. Furthermore, studies focusing on visual recovery have shown excellent recovery of high-contrast visual acuity in the majority of children, but functional and structural studies have shown evidence of irreversible injury and functional decline after ON in children. Although randomized controlled treatment trials have not been performed in children and adolescents with ON, standard of care suggests that the use of high-dose pulse steroids is safe and likely effective. This article reviews current knowledge about the clinical presentation and management of pediatric ON, with attention to associated syndromes and evaluative tools that may inform diagnosis and interventions.
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