Neuro-ophthalmologic diagnosis and therapy of central nervous system trauma

Although direct injury to the orbit and globes can easily result in ophthalmologic disorders, it is less appreciated that distant head injury can similarly result in injury to the retrobulbar afferent visual pathways or cranial nerves. The physician must be suspicious of latent and manifest injuries to the neuro-ophthalmologic system after head trauma and maintain an awareness of the need for timely intervention in a subset of these disorders. Even patients with injuries removed from the eyes should be checked for visual problems, and if any are detected, a careful neuro-ophthalmologic examination should be performed. In most cases, examination and judicious use of neuroimaging will help in choosing the appropriate management for injuries to the afferent and efferent visual systems.