Eye South East Asia Vol.15 Issue 1 2020 6 Paediatric neuromyelitis optica Nurul Najieha Amir, MBBS 1 , Mimiwati Zahari, FRCS (Edin) 1 , Nor Fadhilah Mohamad, M. Ophthal 1 1 Department of Ophthalmology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia. Objective: To report a case of paediatric Neuromyelitis 0ptica (NMO) Method: Case report A 14-year-old girl presented with blurring of vision in her right eyefor 4 days, with associated acute bilateral lower limb weakness and urinary incontinence. At presentation, visual acuity for her right eye was counting fngers and 6/9 in her left eye, with positive right relative aferent pupillary defect. Light brightness and red saturation in her right eye were reduced to 50% as compared to the left eye with right central visual feld defect. The anterior segments and fundoscopy of both eyes were normal. On systemic examination, there were upper motor neuron signs and segmental sensory loss from T1- L2. Motor power for both upper and lower limbs were reduced with hyperrefexia. Blood investigation for Aquaporin 4 Ab was positive. Magnetic Resonance Imaging of the spine showed longitudinal extensive transverse myelitis. She was given intravenous methylprednisolone 1gram daily for 5 days followed by a tapering dose of oral prednisolone. She completed 5 cycles of plasmapheresis. Subsequently, she had near complete recovery with normal lower limb power. Her right eye vision had improved signifcantly to 6/9. She completed 3 cycles of Rituximab infusion. Conclusion: This case report highlights the importance of early diagnosis in paediatric neuromyelitis optica and prompt treatment which may improve the prognosis of the disease. Conficts of interest: The authors report no conflcts of interest. Keyword: Paediatric, Neuromyelitis optica, Immunomodulatory, Plasmapheresis EyeSEA 2020;15(1):6-10 DOI: https://doi.org/10.36281/2020010102 Introduction: Paediatric onset of neuromyelitis optica (NMO) is found in approximately 4% of reported cases. 1 Early diferentiation of NMO from other childhood demyelinating disorders is crucial for institution of appropriate therapy and proper counselling to family and patient. 2 Here we describe a case of a young patient with Neuromyelitis Optica and to emphasize the Correspondence to: Nurul Najieha Amir, Department of Ophthalmology, Uni- versity of Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia. E-mail: najieha.amir@gmail.com Received: January 28,2020 Accepted: February 2,2020 Published: June 30,2020 early diagnosis and prompt treatment that may improve the prognosis of disease and prevent disability. Method: Case report A 14 year old girl presented with acute onset of right eye blurring of vision for 4 days, which was associated with bilateral lower limb weakness and urinary incontinence. She had no fever, upper respiratory tract infection symptoms, loss of appetite or loss of weight. At presentation, visual acuity on the right eye was counting fngers and left eye vision was 6/9 with positive relative aferent pupillary defect on the right eye. Light brightness and red saturation were reduced to 50% as compared to