[Therapy of orbital and retroorbital space occupying processes with optic nerve compression]

Space occupying lesions involving the optic nerve require individual management. Graves' disease is first treated with cortisone: failures of treatment require radiation and operative decompression. Good results have been achieved with cytostatic drugs and, in acute progressive loss of vision, with plasmapheresis. Idiopathic pseudo-tumor orbitae disappears with cortisone, failures of treatment indicate malignant development of a lymphoma, which requires management with cytostatic drugs or radiation. Granulomatous infiltration of the optic nerve in sarcoidosis should be treated first of all with steroids before proceeding to operative treatment. Primary optic nerve tumors such as gliomas and meningeomas should be removed operatively if they are located in front of the chiasm and continue to grow. If the chiasm is involved, radiation is preferable. Doubtful cases of clinically almost indistinguishable pinealomas which are very radiosensitive require primary radiation therapy. Sinus cavernosus fistulas should be treated by selective angiographic occlusion of the fistula. If this is impossible, the internal carotid artery may be occluded by introducing a ballon catheter. Loss of vision after blunt head trauma should be treated with megadoses of steroids, operative treatment is only promising in cases with progressive loss of vision.