Idiopathic Optic Perineuritis in a Pediatric Patient

Optic perineuritis is an inflammatory disorder of the optic nerve sheath, presenting with visual deficits, dyschromatopsia, and pain with extraocular movement, often confused with optic neuritis. Most cases are believed to be idiopathic but can be associated with autoimmune, infectious, and neoplastic etiologies. Treatment involves corticosteroids, and when administered promptly has been associated with rapid recovery. Delays in treatment have been linked to poor visual outcomes. Few pediatric cases have been described. We report a teenager who presented with 2 months of unilateral visual loss and paracentral scotoma, found to have optic perineuritis. She was treated aggressively with high-dose corticosteroids, therapeutic plasma exchange, and intravenous immunoglobulin, but had limited symptomatic recovery attributable to delays in seeking treatment. Optic perineuritis is rare in children but should be included in the differential for visual deficits, especially as delayed treatment is associated with irreversible visual loss. Further studies are needed for children to better identify underlying causes and establish consistent treatment paradigms.