Isolated Bilateral Retrobulbar Optic Neuritis In Childhood

Challenges in Management and Prognosis: A Case Report

Budiman Bintang Prakoso, Syntia Nusanti, Muhammad Sidik
Faculty of Medicine Universitas Indonesia
Kirana Cipto Mangunkusumo Hospital, Jakarta, Indonesia

PURPOSE
To demonstrate isolated bilateral retrobulbar optic neuritis (ON) case in childhood with focus in the management and
prognosis

CASE ILLUSTRATIONS
Eleven years old boy came with sudden blur vision of both eyes. Visual acuity of the right eye 1/300 and left eye 1/60 with
positive relative afferent pupilary defect seen in the right eye with normal optic disc appearance. (Fig.A,B). Intravenous
methylprednisolone 125mg four times daily was given for 3 days.
Magnetic resonance imaging (MRI) of the brain shows focal multiple sclerosis (MS) (Fig.C) with optic nerve involvement
(Fig.D). Patient controlled weekly, the oral steroid therapy was tapered off. Visual acuity improve to 6/6 in the right eye and
6/7.5 in the fellow eye. There were no complain of relapse ON nor other neurological symptoms appear after therapy for 1,5
years follow-up.

(Fig. A, B) Optic disc appearances of the right (A) and left

(B) normal appearance

(Fig.C) MRI Brain shows multi focal MS

(Fig.D) MRI brain shows optic nerve involvement in focal MS

CONCLUSIONS
Pediatric ON is clearly a distinct entity from its adult counterpart. Retrobulbar ON in children with or without episode of
relapse ON, it necessary to perform brain MRI evaluation to explore abnormality in the white matter in a relation to
development of MS. Intravenous MP used in children remains give uncertain benefit for MS development and relapse ON
in the future, therefore valid study on that issue is still required.
KEYWORD : pediatric bilateral retrobulbar optic neuritis, abnormal brain imaging, multiple sclerosis
REFERENCES
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