How is de best treatment ofr a chronic neuritis optic ( 1,2 months of evolution)

Dear Srs.
I am a neurologist in the country em Brazil and next week I received a young boy 14 years old, that started with loss of vision in 1 and half year, in the rigth eye, with midle pain, progressive and there are 6 months also in the left eye.
All the extensive investigations were normal ( MRI, blood investigations like infections, inflamatories, CSF, e fundoscopy, Lebe's investigations, etc, were normal) and the unique abnormal exam was the Evoked Potencial ( Absent of response in the rigth side and very prolonged in the left side) and the ERG was normal.
Nowadays, in the rigth eye his not ha vision and in the left side de visual is 20/400 and the neurologic exam is absolutely normal.
Please the questions is: As the evolution is being progressive, may be will arrive till the blind in the left eye and the blind in the right, is recomended the treatment with metilpredinilosone IV ??, and after prednisone 60 mg a day?? For how long should I mantain the prednisone??
Regarding the long time of lesions without treatment and progress of the sintoms, do you expect any improve?? And is there any indication for precriptions of vitamin, like B complex - A vitmain  or others??

With Respect, Thanks a lot for de responses and sugestions and coments.
Dr. Alexandre do Amaral, MD ( Neurologist)

[John C Hagan III, MD, FACS, FAAO]

Dr. Amaral, I am not a neuro-ophthalmologist. With that qualification these are my thoughts.

1. This is an excellent reference to access the world's literature:
http://emedicine.medscape.com/article/1217290-overview

2. I do not think that steroids would help the problem and would expose the child to all the well know side effects of steroid medication.

3. Assuming all the tests you mentioned were normal and his general health is good at this point I think the working diagnosis would be idiopathic,progressive, bilateral optic neuropathy and that the prognosis is poor.

4. If possible perhaps try to have the child seen by a neuroophthalmologist.


Good luck. If you ever get a definite answer let me know.

JCH MD