Idiopathic optic neuritis of childhood

I saw two children who had painless unilateral visual loss due to papillitis of unknown cause. Loss of visual acuity was moderate to severe and was accompanied by a central scotoma and color vision impairment. In each case the optic disks were pale and swollen, and retinal exudates formed a partial star figure in the macula. Previous diagnostic considerations in one patient had led to an unnecessary neuroradiologic search for an intracranial lesion. Unilateral neuroretinitis is less common than the bilateral papillitis that usually occurs in children, but should not be mistaken for unilateral papilledema. The visual prognosis for unilateral optic neuritis is excellent; both patients improved to normal or nearly normal visual acuity without treatment, although subtle signs of previous optic neuritis persisted.