Neuritis óptica en una población pediátrica: revisión de las tendencias actuales de diagnóstico y tratamiento

Optic neuritis is an inflammation of the optic nerve and may be related to different systemic conditions. The clinical presentation of this pathology usually includes sudden loss of visual acuity (VA) which may be unilateral or bilateral, visual field restriction, pain with eye movements, dyschromatopsia, a relative afferent pupillary defect and optic disk swelling. Optic neuritis in children has specific clinical features and a better prognosis than in adulthood. Although usually appears an underlying viral disease, the main concern for practitioners is the relationship of optic neuritis with multiple sclerosis. In addition to the classical techniques as magnetic resonance imaging (MRI), current tendencies of diagnosis for eye practitioners include new imaging devices as optical coherence tomography (OCT), useful to show a thinning of the retinal fibers layer (RFL) after the inflammatory episode. Regarding the management of these patients, short-term intravenous steroid dosages seem to be the best option to treat acute attacks characterized by a very poor bilateral VA.La neuritis óptica es una inflamación del nervio óptico, que puede relacionarse con diferentes condiciones sistémicas. La presentación clínica de esta patología incluye normalmente pérdida súbita de agudeza visual (AV), que puede ser unilateral o bilateral, restricción del campo visual, dolor al mover los ojos, discromatopsia -defecto pupilar aferente relativo- y edema del disco óptico del disco óptico. La neuritis óptica en niños tiene características clínicas especiales, y un mejor pronóstico que en los adultos. Aunque normalmente parece una enfermedad vírica subyacente, la principal dificultad para los especialistas es la relación de la neuritis óptica con la esclerosis múltiple. Además de las pruebas clásicas como la resonancia magnética (RM), las tendencias actuales de diagnóstico para los profesionales de la salud visual incluyen nuevos dispositivos de imagen tales como la tomografía de coherencia óptica (TCO), que es útil para reflejar el adelgazamiento de la capa de fibras de la retina tras el episodio inflamatorio. Respecto al tratamiento de estos pacientes, la administración de esteroides intravenosos a corto plazo parece ser la mejor opción para tratar los ataques agudos, caracterizados por una AV bilateral muy reducida

Botulinum Toxin as an Alternative to Treat the Spasm of the Near Reflex

We describe the case of an eight-year-old girl with complaints of headaches and blurred vision (uncorrected visual acuity: 0.1 decimal) that showed on examination miotic pupils, pseudomyopia, no ocular motility restrictions, and no associated neurological disease. After initial treatment with cyclopentolate for two months, pseudomyopia persisted with an intermittent and variable esotropia. Spectacles of +1 both eyes and atropine 1% one drop daily were then prescribed. The situation improved and remained stable for several weeks, with pseudomyopia and esotropia reappearing later. Finally, botulinum toxin (2.5 iu Botox®) was injected in the medial rectus muscle on two occasions and a visual therapy program based on the stimulation of fusional divergence, diplopia, and stereopsis consciousness was recommended. This prescription was combined with the use of atropine during the first few weeks. Orthotropia and corrected distance visual acuity of 1.0 were found three months after treatment. The evolution and clinical results of this case report suggest that botulinum toxin in combination with other therapeutic alternatives may be useful in the treatment of spasm of the near reflex