Role of high dose corticosteroids and visual outcome in cases of traumatic optic neuropathy with delayed presentation in a tertiary eye care centre

Abstract

Background: Optic nerve injuries occur in the setting of head injury which is often a consequence of road traffic accidents or falls. Traumatic optic neuropathy (TON) is a potentially blinding complication of head and orbital trauma. Different treatment approaches like different dosages of steroids, surgical decompression and observation alone have been suggested but there is no standardized protocol till date. Object: To study the clinical profile, risk factors, visual outcome in a series of forty five patients of Traumatic Optic Neuropathy (TON) after medical management at our tertiary centre. Methods: Forty five patients reported to outpatient department from January 2018 to June 2019 who have a history of trauma were studied prospectively. After relevant and detailed ocular examination, Intravenous methyl prednisolone 1 gram for 5days and thenoral prednisolone 1 mg/kg in tapering doses for two weeks was administered in all patients irrespective of duration of presentation to the hospital after trauma. Results: The age group involved was predominantly 16 to 45years (80%) with a mean age of 35.31 years. Range of follow up was seen from 5days to 5 months. Males (91%) were outnumbered. Road traffic accidents (73.33%) were found to be the most common cause for TON in our series. Of 45, 10 patients were lost to follow up, rest 35 patients who have been followed steroid regime, 18 (51.43%) showed visual improvement (12 patients had >/=2 line improvement, rest 06 patient had one line improvement). 17(48.57%) patients did not show any improvement. 08 patients were same (no perception of light) till the final follow up. Conclusion: IV methyl prednisolone along with oral steroids as proposed by ONTT has been found effective in our case series of TON even in patients who have very low initial visualacuity and who presented late even after 24 hours of injury till the irreversible damage to optic nerve.No major side effects have been encountered with this steroid regimen. High dose steroid has proven its role in traumatic optic neuropathy.