Spontaneous Visual Recovery From Traumatic Optic Neuropathy After Blunt Head Injury

Wolin, Mitchell J.; Lavin, Patrick

doi:10.1016/s0002-9394(14)74609-4

Cited by 62 publications

(28 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[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. A study of current practice in 16 countries was carried out between 1994 and 1997.…”

Section: Treatment Of Indirect Optic Nerve Injurymentioning

confidence: 99%

Traumatic optic neuropathy

Sarkies

2004

Eye

151

146

View full text Add to dashboard Cite

Section: Treatment Of Indirect Optic Nerve Injurymentioning

confidence: 99%

Traumatic optic neuropathy

Sarkies

2004

Eye

151

146

View full text Add to dashboard Cite

“…(3,6) In the case presented here the patient initially had a visual acuity of no light perception, which gradually improved over time.Cases of visual recovery weeks after an initial VA of NLP are well described in the literature after traumatic optic neuropathy. (3,5,7) In this case, the patient had an initialvisual acuity of no light perception that partially improved during follow-up.Cases of isolated traumatic optic neuropathy with a visual acuity of no light perception that improves over weeks are rare, but have been reported.Reversal of total blindness after chorioretinitis sclopetaria has never been reported in our midst.It is therefore concluded that some cases of trauma can have a good visual prognosis even when presenting with NLP, as seen in this case of chorioretinitis sclopetaria.…”

Section: Discussionmentioning

confidence: 73%

Blindness reversal in corioretinitis sclopetaria

Carvalho¹,

Zacharias²,

Albhy³

et al. 2014

Revista Brasileira De Oftalmologia

View full text Add to dashboard Cite

Corioretinitis sclopetaria is a rare manifestation of ocular trauma which may or may not penetrate the orbit. The aim of this study is to report a case of Corioretinitis sclopetaria after orbital trauma by a firearm bullet that had initial total blindness in the affected eye, and evolved over weeks with partial visual recovery. We report a 12 years old boy, victim of firegun injury, who presented a diagnosis of corioretinitis sclopetaria in his right eye. Initial ophthalmologic examination of this eye showed nonreactive pupil and visual acuity of no light perception. The left eye was normal. The patient underwent excision of the firearm bullet located in the orbit. On the early postoperative, the patient reported seeing light and presented visual acuity of counting fingers at 30 cm. The patient showed steady improvement and after eight months his visual acuity was of 0.15 on the affected eye. In corioretinitis sclopetaria, presented visual acuity is generally low. It is still unclear whether visual loss is caused by damage to retina, optic nerve or both components. Patients with total blindness after trauma usually have no visual prognosis. However, some patients may show visual acuity improvement, such as the case described here. Therefore, in patients victims of blunt ocular trauma with low visual acuity, including no light perception, it is important to monitor these patients and treat, if necessary, due to the possibility of visual recovery.Keywords: Blindness; Chorioretinitis/diagnosis; Eye injuries; Wounds, gunshot; Retina/injuries; Case reports RESUMOA retinopatia esclopetária é uma manifestação rara de trauma ocular que pode ou não penetrar a órbita. O objetivo desse trabalho é relatar um caso de retinopatia esclopetária após trauma orbitário por bala de arma de fogo com amaurose total inicial no olho acometido, que evoluiu ao longo de semanas com recuperação visual parcial. Relatamos um caso de um paciente com 12 anos, sexo masculino, vítima de ferimento por arma de fogo, que apresentava ao exame oftalmológico inicial do olho direito pupila não reagente com acuidade visual (AV) de sem percepção luminosa (SPL) e diagnóstico de retinopatia esclopetária nesse olho. O olho esquerdo apresentava-se normal. O paciente foi submetido à exérese do projétil alojado na cavidade orbitária. No 14° pós-operatório, o paciente referiu enxergar claridade, apresentava AV de conta dedos a 30 cm. Ao longo dos primeiros meses, o paciente apresentou melhora constante da AV e com oito meses de seguimento, apresentava AV de 0,15. Na retinopatia esclopetária, a AV geralmente é baixa. Ainda não é claro atualmente se a perda visual é ocasionada por lesão à retina, ao nervo óptico, ou um misto dos dois componentes. Casos de amaurose total após trauma geralmente não apresentam prognóstico visual. Porém, alguns pacientes podem apresentar melhora da AV, como no caso aqui descrito. Conclui-se assim que em casos traumáticos contusos em pacientes com baixa AV inclusive SPL, deve-se acompanhar esses pacientes e tratar, se necessár...

show abstract

“…[2][3][4][5][6][7][8] The rationale for treatment is as follows: Steroids probably decrease the intraneural or extraneural edema and relieve compression of the nerve fibers. 5 By reducing vasospasm steroids may also limit contusion necrosis of the nerve.…”

Section: Discussion and Management Protocolsmentioning

confidence: 99%

Traumatic Optic Neuropathy

Rode¹,

Hathiram²,

Khattar³

2011

An International Journal of Otorhinolaryngology Clinics

View full text Add to dashboard Cite

Introduction: Traumatic optic nerve damage after craniofacial injury was first described by Hippocrates.1 Although the natural history of traumatic optic neuropathy is unknown, recent studies suggest that high dose steroids and, even surgical decompression of the optic canal or the nerve sheath (in cases of nerve sheath hematoma) may restore vision in selected patients.2-8 The commonest cause of optic nerve trauma is road-traffic accidents, when the patient has poly-trauma with head injury and the visual loss is noticed only after the general condition of the patient improves. Isolated trauma of the optic nerve is usually associated with blunt skull trauma involving fractures of both skull and optical canal, but may also occur from blunt ocular trauma.9 Iatrogenic trauma to the optic nerve is not unknown. Pathophysiology: The part of the optic nerve most vulnerable to blunt trauma of the head is the intracanalicular segment, which by virtue of its bony course is vulnerable to the fractures and compressive-elastic forces of its surrounding bone, which also being unyielding, allows for no space for inflammatory expansion or hemorrhage.10 Optic neuropathy following accidental trauma usually results from two distinct mechanisms: A primary injury as a result of a direct contusive force on the optic canal and nerve, which if untreated results in a secondary ischemia with further damage to the nerve. Investigations: Clinical assessment should include testing of visual acuity, extraocular muscle motility and papillary reactivity, visual field assessment and direct/indirect ophthalmoscopy. Visual evoked potentials (VEPs) to flash stimulation and the electroretinogram (ERG) might be supportive in unresponsive patients in the immediate aftermath of the traumatic event.11,12 The role of neuroimaging remains controversial, and practice varies between institutions. Recently, ultrasonography has been advocated to screen and detect abnormalities in optic nerve diameter. Management: Currently, there is no validated approach to the management of traumatic optic neuropathy. Thus, with numerous conflicting reports on the management of traumatic optic neuropathy, there is little world consensus on the optimal management of this condition. Keeping in mind the above, we have devised a management protocol for the same, simultaneously discussing the role of conservative/medical management as well as the surgical protocols followed by us. Discussion and conclusion: In summary, optic nerve decompression alone or combined with decompression of the nerve sheath may be indicated in selected patients who fail to respond to high-dose intravenous steroids. The definitive role of surgery in the management of traumatic optic neuropathy remains unclear. There is a need for a large, prospective, randomized controlled trial to assess the different therapeutic approaches in traumatic optic neuropathy, but such a trial may be challenging given the low frequency of the condition and the difficulties inherent in randomizing patients.

show abstract

Spontaneous Visual Recovery From Traumatic Optic Neuropathy After Blunt Head Injury

Cited by 62 publications

References 19 publications

Traumatic optic neuropathy

Traumatic optic neuropathy

Blindness reversal in corioretinitis sclopetaria

Traumatic Optic Neuropathy

Contact Info

Product

Resources

About