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System for Focal, Closed-System Central Nervous System Injury
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Traumatic optic neuropathy: an evolving understanding.

Kenneth D Steinsapir1, Robert A Goldberg

  • 1Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA 90025, USA. kenstein@ix.netcom.com

American Journal of Ophthalmology
|May 3, 2011
PubMed
Summary
This summary is machine-generated.

High-dose corticosteroids should not be used for traumatic optic neuropathy due to increased mortality risk and harm to the optic nerve. Further research is needed to define the natural history and identify effective treatments for this injury.

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Area of Science:

  • Ophthalmology
  • Neurology
  • Trauma Surgery

Background:

  • Traumatic optic neuropathy (TON) treatment lacks robust clinical evidence.
  • Small studies and lack of control groups limit treatment progress.
  • TON often co-occurs with head trauma, complicating treatment decisions.

Purpose of the Study:

  • To critically review current treatment strategies for traumatic optic neuropathy.
  • To evaluate the efficacy and safety of corticosteroids and optic canal decompression for TON.
  • To identify research gaps in understanding and treating TON.

Main Methods:

  • Critical review and interpretation of published clinical and basic science studies on TON.
  • Analysis of data from the Corticosteroid Randomization for Acute Head Trauma (CRASH) trial.
  • Examination of animal studies investigating corticosteroid effects on injured optic nerves.

Main Results:

  • The CRASH trial indicated increased mortality with high-dose corticosteroids in patients with acute head trauma (21% vs 18%).
  • Animal studies suggest high-dose corticosteroids are toxic to the injured optic nerve.
  • Clinical efficacy of corticosteroids for TON is not demonstrated, and optic canal decompression benefits remain unclear.

Conclusions:

  • High-dose corticosteroids should be avoided for TON, especially in patients with concomitant head injury, due to increased mortality risk.
  • Current evidence does not support the use of corticosteroids for TON.
  • Further research is required to establish the natural history of TON and develop effective treatments.