Traumatic Optic Neuropathy After Head Trauma: Pathophysiology, Interventions, and Evidence From Meta-Analysis

Area of Science:

• Ophthalmology
• Neurosurgery
• Trauma Care

Background:

• Traumatic optic neuropathy (TON) is a severe vision impairment following head trauma, often leading to irreversible vision loss.
• Current management strategies for TON lack consensus, highlighting a critical need for evidence-based treatment guidelines.

Purpose of the Study:

• To systematically review and meta-analyze the efficacy and safety of surgical optic canal decompression versus corticosteroid therapy for TON.
• To compare visual and structural outcomes between surgical and non-surgical interventions for TON.

Main Methods:

• A comprehensive literature search was performed across major databases (PubMed, Embase, Web of Science, Cochrane Library) for studies from 2005 to 2025.
• Included studies were randomized controlled trials and observational studies assessing visual or structural outcomes in TON patients.
• Data were synthesized using random-effects models, with subgroup analyses for intervention timing, injury type, and severity; risk of bias was evaluated.

Main Results:

• Thirty-four studies with 1046 patients indicated surgical decompression significantly improved visual outcomes (62% vs. 37%) compared to corticosteroids.
• Early surgery (≤7 days) and treatment for indirect TON showed superior results (OR=2.91 and OR=2.62, respectively).
• Surgery also preserved retinal nerve fiber layer and reduced optic atrophy, with comparable mild adverse events.

Conclusions:

• Early surgical optic canal decompression appears more effective than corticosteroids for TON, especially in indirect injuries.
• While surgery shows promise without increased risks, the evidence base is limited, necessitating high-quality randomized trials.
• Corticosteroids may serve as an adjunct when surgery is not feasible, but further research is crucial for treatment standardization.