Pediatric Optic Neuritis Clinical Characteristics and Predictors of Visual Recovery: A Structured Narrative Review

Background: Pediatric optic neuritis often produces severe visual loss followed by substantial recovery, but its prognosis varies with the underlying inflammatory disorder. Normal high-contrast acuity does not exclude persistent contrast, field, or structural abnormalities. Objective: To examine presenting characteristics, etiological classification, and predictors of visual recovery, distinguishing recovery of an affected eye from relapse and future demyelinating disease. Methods: A targeted PubMed-based narrative review evaluated prospective pediatric cohorts, longitudinal retrospective series, antibody-associated studies, diagnostic consensus statements, and treatment recommendations available through October 24, 2026. Adult evidence was identified explicitly when used indirectly. Results: Prospective cohorts generally demonstrate substantial improvement during the first six months, with considerable variation in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), multiple sclerosis, and aquaporin-4-associated disease frequencies across settings. Presenting acuity, age, laterality, and disc swelling have inconsistent independent prognostic value. Etiological diagnosis, recurrent attacks, early recovery trajectory, and established optic atrophy provide more clinically useful context. MOGAD can produce striking acute loss and bilateral disc edema with favorable acuity recovery despite retinal nerve fiber layer thinning. Aquaporin-4-associated optic neuritis carries greater concern for permanent visual disability. Brain MRI abnormalities and oligoclonal bands are relevant to future multiple sclerosis but are not equivalent to direct predictors of visual recovery. Conclusions: Counseling should combine etiology, repeated functional testing, and longitudinal structural assessment. Early treatment and escalation are important in severe attacks, while precise individual prediction remains limited by small cohorts, heterogeneous outcomes, and treatment-selection bias.