Clinical Spectrum of Pediatric Optic Neuritis in Indian Children

Abstract

Purpose: To study the clinical spectrum of pediatric optic neuritis in Indian children at a tertiary
care centre.
Methods: A retrospective study of patients diagnosed with optic neuritis below 20 years of
age at a tertiary care centre in India over a 3 year period were reviewed. The ophthalmological
examination findings, Goldmann perimetry, electrophysiological tests and magnetic resonance
imaging (MRI) were reviewed.
Results: The study reviewed 28 patients (44 eyes) and found a mean age of 12.6±4.9 years
(2-20 years) having a follow-up record for a mean period of 6.3±4.9 months (0.3-38 months).
32.1% were females (F: M-0.47). Six patients (20.7%) had a viral prodrome and 12 (42.9%)
complained of painful ocular movements. The mean baseline visual acuity (VA) was 1.80±0.6
logMAR units (Range=0.2-3.0 logMAR units) and the last best visual acuity was 0.43±0.4 log
MAR units (Range=0-1.79 logMAR units). Thirty six eyes (81.8%) had a visual acuity at or
below 3/60 and 40 eyes (90.9%) of 6/60 or lower of the snellen chart at the time of presentation.
The mean contrast sensitivity at presentation was 1.02±0.46 (range=0-1.65). 16 pts (57.1%)
had a bilateral presentation and 20 patients (71.4%) had either unilateral or bilateral papillitis.
All the patients were given pulse dexamethasone (3-5 mg/kg/d) for three consecutive days
followed by oral prednisolone (1-1.5 mgKg/day) for 11 days. At 1 week, 21 out of 44 eyes
(47.7%) had a visual acuity ≥6/18 of the snellen chart. Three patients showed demyelination
suggestive of multiple sclerosis (MS) on MRI brain and were diagnosed as probable MS.
A total of 9 eyes (20.5%) of 6 patients (20.7%) had a recurrence. Those below 10 years of
age presented more commonly with papillitis compared to teenagers (p value=0.01). All the
parameters were similar in males and females.
Conclusion: Pediatric optic neuritis patients are associated with a good visual outcome and a
faster recovery. There are no gender differences in either the presentation or the visual recovery.
Papillitis was more often seen in the children below 10 years of age. None of the patients
developed clinically definite multiple sclerosis.