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Parainfectious Optic Neuritis: Manifestations in Children vs Adults

Rappoport, Daniel MD; Goldenberg-Cohen, Nitza MD; Luckman, Judith MD; Leiba, Hana MD

Journal of Neuro-Ophthalmology: June 2014 - Volume 34 - Issue 2 - p 122–129
doi: 10.1097/WNO.0000000000000113
Original Contribution

Background: Parainfectious optic neuritis may appear at any age. The aim of our report was to compare the clinical manifestations and outcomes of this form of optic neuritis between children and adults.

Methods: The study sample consisted of all patients diagnosed with parainfectious optic neuritis evaluated by 2 neuro-ophthalmology services between 2005 and 2012. Data were collected retrospectively from the medical files. Findings were compared between patients aged 0–18 years and 19 years or older.

Results: Ten children (50% female) and 8 adults (50% female) met the study criteria. Mean duration of follow-up was 29.4 months (range, 2–72 months) in the pediatric group and 14.2 months (range, 5–80 months) in the adult group. Respective rates of bilateral disease were 50% and 38%, and all patients had optic disc swelling. The associated pathogen was identified in 60% of the pediatric group, mainly Mycoplasma pneumoniae, and 75% of the adult group, in which no microorganism predominated. The interval from the febrile illness to symptom onset was 6 days (range, 1–14 days) in the pediatric group and 19.5 days (range, 14–30 days) in the adult group. Acute disseminated encephalomyelitis (ADEM) was diagnosed in 40% (4/10) of the children and none of the adults. Final visual outcome was 20/30 or better in all patients. There was a higher frequency of bilateral disease in prepubescent vs postpubescent children.

Conclusions: Parainfectious optic neuritis is associated with a favorable visual prognosis regardless of age. Children tend to manifest visual symptoms sooner after the antecedent infectious illness and more often bilaterally and in conjunction with ADEM. The causative agent is isolated less frequently in children compared with adults.

Department of Ophthalmology (DR, HL), Kaplan Medical Center of Israel, Rehovot, Israel; Hebrew University (DR, HL), Hadassah Medical Center, Jerusalem, Israel; Krieger Eye Research Laboratory (NG-C), Felsenstein Medical Research Center, Petach Tikva, Israel; Pediatric Ophthalmology Unit (NG-C), Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Department of Radiology (JL), Rabin Medical Center; Petach Tikva, Israel; and Sackler Faculty of Medicine (NG-C), Tel Aviv University, Tel Aviv, Israel.

Address correspondence to Hana Leiba, MD, Department of Ophthalmology, Kaplan Medical Center of Israel, POB 1, Rehovot 76100, Israel; E-mail:

Supported in part by the Zanvyl and Isabelle Krieger Fund, Baltimore, MD (NG-C).

Presented as a poster at the NANOS meeting, Snowbird, UT, February 2013.

The authors report no conflicts of interest.

© 2014 by North American Neuro-Ophthalmology Society