Management of Traumatic Optic Neuropathy—A Study of 23 Patients

Abstract

Twenty three patients with traumatic optic neuropathy were managed by medical and surgical treatment as follows. High dose intravenous steroids were initiated in all patients. If visions did not improve significantly after 24 to 48 hours decompression of an optic nerve sheath haematoma by medial orbitotomy and neurosurgical decompression of the optic canal were considered based on computed tomographic scan findings. Nine of 16 patients who received steroids only showed significant improvement. One of three showed improvement on optic nerve decompression after steroid failure; three or four showed improvement with combined optic nerve sheath decompression by the medial orbitotomy and decompression of the optic canal by frontal craniotomy. A lucid interval of vision after injury and an enlarged optic nerve sheath were associated with an improved prognosis. Five of the 23 patients had a lucid interval and all five had a final improved vision, while only five of 18 patients without a lucid interval improved. Similarly seven of the nine with an enlarged optic nerve sheath showed improvement while only three of 10 patients (three bilateral cases) who presented with no light perception improved with medical and surgical treatment. While a prospective controlled study of the management of traumatic optic neuropathy is necessary this preliminary study suggests that treatment of traumatic optic nerve sheath haematoma by optic nerve sheath decompression should be considered in selected patients.Although the natural history of traumatic optic

Traumatic optic neuropathy

“…Retrospective reports of the use of high-dose steroids are also subject to similar criticisms. [14][15][16] The natural history of traumatic optic neuropathy has not been studied prospectively, but several authors have reported that spontaneous recovery may occur in at least a third of patients. [17][18][19] There has been no randomised, placebo-controlled study of patients with indirect optic nerve injury.…”

Surveillance of traumatic optic neuropathy in the UK

“…There were reports in the TON case literature of 0-48% 3-7 rate of spontaneous improvement, 44-82% 8,9 rate of improvement with varying doses of steroid treatment, and 37-71% 10-13 rate of improvement with surgical optic nerve decompression. The 2001 International Optic Nerve Trauma Study (IONTS), 14 the only prospective international observational study, and the recent TON Cochrane reviews 15,16 did not recommend a standardized investigation or treatment protocol.…”

Visual improvement and pain resolution in traumatic optic nerve sheath meningocele treated by optic nerve sheath fenestration

“…In the past three decades, there have been a total of seven cases of successful treatment of TON with enlarged optic nerve/sheath in imaging through ONSF (Goldenberg-Cohen et al, 2004;Guy et al, 1989;Hupp et al, 1984;Mauriello et al, 1992;Muthukumar, 1997;Sergott et al, 1990). The detailed clinic course, imaging and surgical findings were compared with our two cases in Table 1 (Table 1).…”