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Traumatic optic neuropathy-Clinical features and management issues.

Patrick Yu-Wai-Man1

  • 1Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK ; Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK ; UCL Institute of Ophthalmology, University College London, London, UK ; Moorfields Eye Hospital, London, UK.

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|June 9, 2015
PubMed
Summary

Traumatic optic neuropathy (TON) can cause severe vision loss after head injuries. While management is debated, conservative approaches show potential for spontaneous visual recovery, warranting careful consideration of intervention risks.

Keywords:
head injuryoptic canal fractureoptic nervesteroidstraumatic optic neuropathy

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Area of Science:

  • Ophthalmology
  • Neurology
  • Trauma Surgery

Background:

  • Traumatic optic neuropathy (TON) is an uncommon yet severe cause of vision loss following head trauma.
  • It predominantly affects young adult males but also occurs in children.
  • Diagnosis is typically clinical, but can be challenging in patients with impaired mental status.

Purpose of the Study:

  • To review the diagnosis, prognosis, and controversial management strategies for traumatic optic neuropathy.
  • To highlight the importance of baseline visual acuity and other prognostic factors.
  • To discuss the risks and benefits of observation versus intervention in TON.

Main Methods:

  • Review of clinical history and examination findings.
  • Assessment of prognostic factors including visual acuity, loss of consciousness, and neuroimaging.
  • Evaluation of management options: observation, systemic steroids, and surgical decompression.

Main Results:

  • Prognosis is largely determined by baseline visual acuity.
  • Poor prognostic indicators include loss of consciousness, lack of vision improvement within 48 hours, absent visual evoked responses, and optic canal fractures.
  • Spontaneous visual recovery is observed in a significant proportion of conservatively managed patients.

Conclusions:

  • The management of TON remains controversial due to weak evidence supporting interventions.
  • Conservative management may lead to spontaneous visual recovery.
  • Potential risks of systemic steroids and surgical decompression must be weighed against benefits, especially given the possibility of spontaneous improvement.