Abstract:

Background: We present a rare case of atypical bilateral optic neuritis/neuroretinitis in a 
9-year-old child, in whom extensive diagnostic evaluation failed to identify an underlying etiology. 
Objective: To illustrate diagnostic challenges, highlight the role of multimodal imaging 
particularly optical coherence tomography (OCT) - and demonstrate the importance of long-term 
follow-up. 
Methods: The patient underwent extensive laboratory, serological, imaging, and neuro
ophthalmological testing including CT, MRI, EEG, lumbar puncture, OCT RNFL/GCC analysis, 
and fundus imaging. A 5-year OCT-based structural follow-up was completed. 
Results: Despite comprehensive diagnostic work-up, no definitive etiology was confirmed. OCT 
revealed progressive thinning of RNFL and GCC over the first two years, followed by structural 
stabilization. Visual acuity recovered to 0.9–1.0 bilaterally. 
Conclusions: This case demonstrates the diagnostic difficulty of atypical pediatric optic neuritis 
and emphasizes the value of long-term OCT monitoring for assessing structural damage, guiding 
therapy, and predicting outcomes. 

Keywords: optic neuritis, neuroretinitis, pediatric ophthalmology, OCT, optic nerve atrophy. 

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