Neuro-ophthalmologic diagnosis and therapy of central nervous system trauma

Careful examination and judicious use of neuroimaging will lead to the initiation of appropriate management for injuries of the afferent and efferent visual systems. This article concentrates on those aspects of neuro-ophthalmologic trauma that are most relevant to the neurosurgeon, particularly those disorders that are commonly faced when caring for acutely injured patients. Although direct injury to the orbit and globes can easily result in neuro-ophthalmologic disorders, it is less appreciated that distant head injury can similarly result in injury to the retrobulbar afferent visual pathways or cranial nerves. It is therefore necessary that the neurosurgeon be suspicious of both latent and manifest injuries to the neuro-ophthalmologic system after head trauma, and maintain awareness of the need for timely intervention in a subset of these disorders. Therefore, even patients with injuries removed from the eyes should be checked for visual problems, and, if any are detected, an ophthalmologist or neuro-ophthalmologist should be consulted.