Signs and Symptoms

Symptoms of optic neuritis may vary for each child. However, the most common symptom is sudden loss or decrease in vision, including blurred vision, dark vision, dim vision, or vision in which the contrast or colors seem diluted or "turned down." Another common symptom of optic neuritis is pain or discomfort in or around the eye that worsens with movement.

There is a strong connection between optic neuritis and multiple sclerosis (MS), another disorder associated with damage to the myelin covering. In 20 to 25 percent of patients with MS, optical neuritis was their first symptom. Further, the risk of developing MS increases steadily during the first 10 years after an initial onset of optical neuritis. However, not everyone with optic neuritis has or will develop MS.

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Diagnosis

An accurate and early diagnosis of optic neuritis is critical in managing your child's disease and quality of life.

In making a diagnosis of optic neuritis, your child's doctor will first start by conducting a thorough eye and physical examination, asking about any symptoms your child is experiencing, including when they started and how they've eased or progressed over time. Your child's doctor will also record their full medical history, including information about your immediate and extended family's medical history.

Your child may also have an eye exam by an ophtalmologist who will look for optic nerve damage. Evoked potentials test, which records electrical activity in the brain when nerves are stimulated, may also be conducted.

Next, your child may have a magnetic resonance imagining (MRI) test of the brain. An MRI of the brain is a non-invasive procedure that uses powerful magnets and radio waves to construct clear, detailed pictures of brain tissues. A brain MRI is able to detect lesions or inflammation in the brain, which may indicate your child has multiple sclerosis (MS), or is at a high risk of a recurrent episode of optic neuritis, and therefore at risk for developing MS. However, even if your child has a normal MRI scan, this does not necessarily mean that they will not experience another episode of optic neuritis in the future.

Finally, in some cases, your child may also have a lumbar puncture or spinal tap to help in the diagnosis of potential MS. The CSF is the fluid that bathes, cushions and protects the brain and spinal cord. It flows through the skull and spine in the subarachnoid space, which is the area inside the arachnoid membrane.

Additional visual tests may also be conducted.

A diagnosis of optic neuritis is based upon an evaluation of your child's symptoms along with the results of their physical exam and tests.

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Treatment

Children and adolescents with optic neuritis receive treatment at our Regional Pediatric Multiple Sclerosis Center. Our team of experts specializes in optic neuritis and related diseases. They work with each patient to develop a unique treatment plan, including long-term follow-up care specifically tailored to his or her needs. When necessary, we also collaborate with other specialists at UCSF or elsewhere to ensure that your child receives the most comprehensive care possible. Additionally, because we are part of an international network of six pediatric MS centers sponsored by the National Multiple Sclerosis Society, we have access to the latest information, research and treatments.

In the majority of children, vision problems and eye pain will improve dramatically or disappear completely within a few days or weeks. Sometimes it will take up to six months for full recovery. However, these patients may still suffer from long-term vision problems, ranging in severity.

Treatment for optic neuritis may vary depending on the severity of your child's condition and whether he or she is determined to be at a high risk for recurrent episodes and developing multiple sclerosis (MS). Some children are treated with intravenous (IV) and/or oral steroids, which have been shown to accelerate recovery but not to change the ultimate recovery of your child's vision. Also, research has shown that high doses of intravenous (IV) steroids in patients who are at a high risk of developing MS may delay the onset of MS. However, at this time, there is no single treatment that will absolutely prevent the development of MS in high-risk children with optic neuritis.

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