J Korean Med Assoc.  2024 Aug;67(8):524-530. 10.5124/jkma.2024.67.8.524.

Pediatric optic neuritis

• Surl D
• Han J

• KMID: 2558689
• DOI: http://doi.org/10.5124/jkma.2024.67.8.524

Abstract

Background
Pediatric optic neuritis is a demyelinating optic nerve inflammation in children, characterized by acute vision loss and visual field defects, often accompanied by eye movement pain, color vision abnormalities, and relative afferent pupillary defects. It can manifest as an isolated episode or as part of broader demyelinating disorders such as multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease. Its incidence varies globally, with recent studies defining it as optic neuritis in individuals aged <16 years.
Current Concepts
Pediatric optic neuritis has distinct clinical features compared to its adult counterpart, particularly in presentation patterns and associated systemic diseases. Children often experience greater visual acuity deficits and are more likely to develop bilateral eye involvement, severe optic disc swelling, and accompanying encephalopathic features than adults. Epidemiological studies have shown that it is relatively rare, with varying incidence rates across different regions. Diagnostic criteria are primarily based on clinical assessment, magnetic resonance imaging findings, and serological tests, including antibodies against specific biomarkers such as anti-MOG and anti-aquaporin-4 antibodies. Treatment strategies for pediatric optic neuritis involve high-dose corticosteroids followed by tapering and, in severe cases, plasma exchange or intravenous immunoglobulins. Long-term management may require immunosuppressants or biological agents, particularly in cases progressing to MS or NMOSD.
Discussion and Conclusion
Understanding the unique aspects of pediatric optic neuritis is crucial for appropriate management and improving outcomes. Further studies are needed to refine diagnostic and therapeutic approaches for this condition.

Keyword

Child; Optic neuritis; Multiple sclerosis; Neuromyelitis optica; Myelinoligodendrocyte glycoprotein; 소아; 시신경염; 다발경화증; 시신경척수염스펙트럼장애; 수초희소돌기아교세포당단백질