Successful Combination Therapy of Optic Canal Decompression and Steroid Administration for Traumatic Optic Neuropathy...

Traumatic optic neuropathy (TON) is a rare complication caused by head injury in children. TON treatment has employed conservative treatment, steroid administration, and surgical procedures; however, which treatment is preferable remains controversial. We herein present a case of a 10-year-old boy with a TON-complicated head injury after falling from a two-meter-high slide in a park. Initial head computed tomography (CT) revealed the right optic canal fracture, and the patient complained of right visual impairment. He was diagnosed with TON, and surgical right optic canal decompression was performed at six hours post-injury. On postoperative day 2, his right visual acuity (VA) was 20/200, and his right eye developed a relative afferent pupillary defect, prompting a high-dose prednisolone administration. On day 12 post-injury, his right VA improved to 20/30. This clinical course suggests that a combined approach of optic canal decompression and steroid therapy was effective in this case. Further investigation is needed to identify optimal treatments that contribute to favorable visual outcomes for TON management in children. However, in pediatric patients, aggressive treatment may be warranted to prevent permanent visual impairment, with decisions made based on individual background factors and neurological symptoms.