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Traumatic optic neuropathy: a review.

Arjunan Muthu Kumaran1, Gangadhara Sundar2, Lim Thiam Chye3

  • 1Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

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Summary
This summary is machine-generated.

Traumatic optic neuropathy (TON) causes significant vision loss. This review clarifies diagnosis and management, recommending conservative care for mild cases and surgery only when compression is evident.

Keywords:
corticosteroid therapyneuroprotection and neuroregenerationoculofacial traumaoptic nerve decompressiontraumatic optic neuropathy

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Area of Science:

  • Ophthalmology
  • Neurology
  • Trauma Surgery

Background:

  • Traumatic optic neuropathy (TON) is an uncommon but severe condition leading to substantial visual impairment.
  • Lack of standardized diagnostic and management guidelines contributes to variability in patient care.
  • Existing treatment approaches, including conservative, medical, and surgical interventions, differ significantly across institutions.

Purpose of the Study:

  • To critically evaluate the existing literature on the investigation and management of traumatic optic neuropathy.
  • To establish evidence-based recommendations for the diagnosis and treatment of TON.
  • To explore potential future therapeutic strategies for managing TON.

Main Methods:

  • A comprehensive literature search was conducted across PubMed, MEDLINE, PROSPERO, CENTRAL, and EMBASE for articles on traumatic optic neuropathy.
  • Inclusion criteria focused on English-language human adult studies published within the last 10 years, excluding case reports and small case series.
  • A total of 23 relevant articles were selected after initial retrieval and relevance screening of 2,686 articles.

Main Results:

  • Traumatic optic neuropathy is primarily a clinical diagnosis, with visual-evoked potential aiding in diagnosis and prognosis.
  • Computed tomography is valuable for identifying optic canal fractures and associated injuries.
  • Magnetic resonance imaging is best reserved for specific, stable patient cases; conservative management is suitable for mild TON, while steroids have questionable efficacy and potential risks.

Conclusions:

  • Standardized diagnostic and management protocols for traumatic optic neuropathy are needed.
  • Visual-evoked potential and CT scans are key diagnostic tools.
  • Treatment decisions, including the judicious use of surgery for decompression, should be individualized based on clinical and radiological findings.