Traumatic Optic Neuropathy - to Treat or to Observe?

Abstract

We present a case of acute traumatic optic neuropathy in 54 year old male patient. The patient presented with acute loss of vision in the right eye due to a blunt trauma to the eye. Lid haematoma and subconjunctival hemorrhage were present. Fluorescein staining was negative, anterior chamber and lens was clear. Intraocular pressure was normal. Retina and optic nerve head appeared normal on fundoscopy. The vision was “counting fingers at 1 meter” in the right eye. Color test indicated color perception dysfunction of the right eye. Relative afferent pupillary defect (RAPD) was positive. Ocular ultrasound, orbital X ray and CT scan was normal, but visual evoked potentials test was pathologic. The consideration was made whether to treat a patient or not since there are no consensus on the treatment of traumatic optic neuropathy. We decided to treat the patient immediately with the megadoses of steroids following the protocol suggested by Cerovski. The patient responded well to the treatment and recovered vision to normal.

Endoscopic Optic Nerve Decompression for Patients with Traumatic Optic Neuropathy: Is Nerve Sheath Incision Necessary?

“…Currently, the best treatment for TON patients remains controversial [8,9,10,11,12,13]. Although meta-analysis has shown that both administrations of high-dose steroid and/or surgical decompression contributed to the prognosis of TON, a spontaneous visual recovery rate of 20-38% has also been reported for indirect TON cases [8,9,10].…”

“…Although meta-analysis has shown that both administrations of high-dose steroid and/or surgical decompression contributed to the prognosis of TON, a spontaneous visual recovery rate of 20-38% has also been reported for indirect TON cases [8,9,10]. Moreover, whether nerve sheath incision should be performed during endoscopic optic nerve decompression is still under debate [6,13].…”

Ocular Injuries in Association with Middle Third Facial Injuries in Developing Countries: A Prospective Study

“…Patients who had only soft tissue injuries of the facial region were also not included in this study. (Table 1 and Graph 1): This study revealed that RTA was the major cause of injury and accounts for 77% (156) followed by fall 12.9% (26), and assault 6.9% (14); other causes like sports injury or industrial accidents were only 2.4% (5). Among RTA cases, MTWs were the major (76%, 120) cause of injury.…”

“…13 In our study, 5.4% (11) of patients had optic neuropathy, out of which 2.4% (5) had reduced visual acuity at the end of 3 months follow-up. Samardzic et al 14 followed protocol suggested by Cerovski and reported 57.5% of patients on treatment with steroids showed visual improvement in their study. For optic neuropathy, Cerovski suggested that treatment should start preferably within the first 8 hours with megadoses of steroids for otherwise healthy individuals, because all patients were usually scared and psychologically traumatized and expect some sort of treatment when the vision loss is severe.…”

Eye-Directed Overpressure Airwave-Induced Trauma Causes Lasting Damage to the Anterior and Posterior Globe: A Model for Testing Cell-Based Therapies

“…Traumatic optic neuropathy, which can occur after blast or blunt trauma, 6,13,14 is induced by 2 different injury mechanisms: primary (shearing of the axons and ischemia) and secondary (initial damage and death of the retinal ganglion cells). 15 Given that the majority of Bar graphs of cytokines altered or trending toward an increase after injury. Since changes at 3 and 7 days posttrauma were comparable for most cytokines we also show all sham and all trauma groups combined.…”