Clinical features, management, and prognosis factors of traumatic optic neuropathy

We provide a comprehensive clarification of the demographics, clinical features, management, prognostic factors, and complications of traumatic optic neuropathy (TON). About 6068 patients from 109 studies were included. The pooling results indicated that TON was male-dominated (84 %) with road traffic accidents as the leading cause (67 %). After trauma, 46 % of cases had no light perception (NLP), and the most frequent associated injury was craniofacial fractures (70 %). Optic canal fractures (OCF) were detected in 34 % of cases via computed tomography and in 47 % intraoperatively. The general visual improvement rate of conservative treatment, steroid pulse therapy (SPT), optic nerve decompression (OND) and intravenous erythropoietin injection were 34 %, 48 %, 56 %, and 61 %, respectively. OND and SPT showed similar efficacy in patients with both NLP (37 % vs. 28 %) and residual vision (76 % vs. 73 %), but were superior to observation only in patients with residual vision. Patients without OCF also responded similarly to OND (57 %) and SPT (62 %), whereas those with OCF showed a higher response rate to OND (53 %) compared to SPT (24 %). Early intervention (within 7 days post-trauma) improved outcomes for both OND and SPT. Complications from OND were rare. TON mainly affects males, causes severe vision impairment, and is often associated with craniofacial fractures. OND may provide greater benefit than SPT for patients with OCF, while both treatments appear similarly effective for those without OCF, regardless of baseline vision status; however, heterogeneity in the definition and diagnostic criteria of TON, as well as variability in study designs, warrants cautious interpretation of these findings.