Pediatric Optic Neuritis - MOG/NMO/LP On All, or Some (Focused Work-Up)

There is a wide differential for pediatric optic neuritis (ON) and the diagnostic workup for underlying etiologies needs to be carefully considered. Furthermore, bedside clinical pearls used to narrow the differential in adult ON don't always apply in pediatric ON. Children with ON are more likely to present with features such as optic nerve head edema, absence of pain, severe initial vision loss, and bilateral involvement, which would all be considered atypical for adult patients. Obtaining multiple imaging studies and lumbar puncture in adults with ON is routine, but in children these tests may be more controversial as sedation is required for the youngest patients. With the now wide availability of NMO and MOG antibody serum testing, many cases of pediatric ON associated with these disorders can be diagnosed with routine bloodwork, but these tests can take 10-14 days to return.