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Optic Neuritis (ON)

What is Optic Neuritis (ON)?

Optic neuritis is inflammation of the optic nerve. The optic nerve is a collection of nerves that carries visual information from the eyes to the brain. Optic neuritis can present in both children and adults. 

What are the signs and symptoms of Optic Neuritis (ON)?

Patients typically experience eye pain, specifically pain that worsens with eye movement. This is typically followed by partial or complete loss of vision. One or both eyes may be affected. 

How is Optic Neuritis (ON) diagnosed?

Children presenting with symptoms consistent with optic neuritis will be evaluated in a detailed neurological exam that focuses on the eyes. Further testing includes an MRI of the brain, orbits and spinal cord to identify possible abnormalities as well as a lumbar puncture to obtain cerebrospinal fluid (CSF) to evaluate for signs of inflammation or infection. Blood work is also performed to look for potential causes of optic neuritis including testing for antibodies (e.g., anti-AQP4 and anti-MOG antibodies) and testing for infections that are associated with optic neuritis.  

What are the causes of Optic Neuritis (ON)?

Optic neuritis can occur secondary to numerous conditions including autoimmune disorders such as multiple sclerosis, neuromyelitis optica or anti-MOG associated disease. Other etiologies include infectious and inflammatory causes. 

How is Optic Neuritis (ON) treated?

Optic neuritis is typically treated with high doses of steroids. These can be given orally or intravenously (IV). They are typically well tolerated. When patients do not respond to steroids, plasma exchange (PLEX) or intravenous immunoglobulin (IVIG) may be used. PLEX is used to clean the blood of inflammatory components. It requires special IV access and a portable machine to clean the blood. A patient’s blood is circulated through the machine and proteins such as antibodies are removed. A therapy session takes about 90 minutes and is usually well tolerated. A patient usually needs five to seven treatments to complete a PLEX course. IVIG is an infusible therapy that has been used extensively in pediatrics. IVIG is a collection of antibodies collected from blood donors and pooled together. When infused into patients, the antibodies are thought to cause a reduction or blocking of the patient’s abnormal immune response. 

If the cause of optic neuritis is secondary to infection, antibiotics may be needed. Recovery from optic neuritis is typically based on the underlying cause and can range from minimal to complete recovery. 

If an underlying cause such as multiple sclerosis or neuromyelitis optica (NMO) is discovered, patients will need to start a preventative medication that works to suppress the immune system to prevent future attacks. This decision will be made after discussing all the options with your child’s health care provider. These medications cause more profound immune suppression and should be used by centers that have experience in prescribing these medications.

Optic Neuritis (ON) Doctors and Providers