Traumatic optic neuropathy management: a systematic review

Area of Science:

• Ophthalmology
• Neurology
• Trauma Surgery

Background:

• Traumatic optic neuropathy (TON) affects up to 8% of traumatic brain injury (TBI) patients, with subclinical damage being more prevalent.
• Sensitive testing reveals visual field defects or optic atrophy in over half of moderate to severe TBI cases.
• Orbital compartment syndrome necessitates urgent intervention to prevent permanent optic nerve dysfunction.

Approach:

• Systematic review of treatments for traumatic optic neuropathy.
• Adherence to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
• Inclusion of three randomized controlled trials evaluating intravenous methylprednisolone (IVMP), erythropoietin, and levodopa-carbidopa.

Key Points:

• No demonstrated benefit for IVMP, erythropoietin, or levodopa-carbidopa in treating TON.
• High-dose IVMP linked to increased mortality in TBI patients.
• Optic canal decompression shows no efficacy for TON.

Conclusions:

• Medical treatments for TON lack evidence of benefit.
• High-dose IVMP poses a significant harm risk.
• Orbital compartment syndrome is a distinct emergency requiring prompt medical and surgical management to preserve vision.