Post-infectious optic neuritis in children: a systematic review of recent evidence

Abstract

Abstract Aim of the research was to outline etiological triggers, clinical presentation, diagnostic approaches, treatment strategies, visual as well as neurological outcomes. Methods: Twenty-three patients with persisting visual symptoms after viral infections have been examined. A series of tests have been undergone in order to establish visual pathways alteration. Results: A probable post-infectious immune-mediated etiology was identified in the majority of cases, accounting for approximately 65% (n≈15) of patients. These children typically developed visual symptoms within 1–4 weeks after resolution of a self-limited viral illness and demonstrated clinical and paraclinical features consistent with optic nerve inflammation. In approximately 13% of cases, visual pathway impairment was attributed to direct or para-infectious viral involvement of the optic nerve. These cases were characterized by an acute or subacute onset of visual symptoms occurring during or shortly after the viral illness, in the absence of radiological features of demyelination. The etiological agents most frequently implicated included varicella-zoster virus (post-varicella and postherpetic forms), measles virus, and other common neurotropic viruses, based on clinical history, serological evidence, and temporal association with infection. Conclusions: Post-infectious optic neuritis in children is most commonly immune-mediated, with a smaller proportion associated with post-viral demyelinating processes or direct viral effects on the optic nerve. Accurate diagnosis relies on a combination of clinical history, neuroimaging, and immunological markers to guide appropriate management. Early recognition and treatment are associated with generally favorable visual outcomes in the pediatric population.