Traumatic Optic Neuropathy-Craniofacial Fracture Patterns and Management.

Area of Science:

• Ophthalmology
• Neurosurgery
• Trauma Surgery

Background:

• Traumatic optic neuropathy (TON) can lead to permanent vision loss in up to 50% of patients.
• Diagnosing and managing TON presents significant clinical challenges.
• Identifying specific craniofacial fractures associated with TON is crucial for early detection and intervention.

Purpose of the Study:

• To identify craniofacial fractures associated with traumatic optic neuropathy (TON).
• To compare visual outcomes in TON patients managed with observation versus steroid-based treatment.

Main Methods:

• Retrospective review of CT scans (2018-2022) for craniofacial fractures in acute facial trauma patients.
• Analysis of TON patient outcomes (2013-2022) comparing steroid treatment (IV methylprednisolone) with observation.
• Multivariate logistic and linear regressions used to assess fracture associations and treatment outcomes.

Main Results:

• Out of 2374 patients with facial fractures, 21 (0.9%) had TON.
• Sphenoid sinus fractures showed the highest odds of TON (aOR 25), followed by LeFort III (aOR 13) and NOE fractures (aOR 7).
• TON patients treated with steroids had significantly better visual acuity improvement (62% vs. 33%) and a 57-day faster recovery compared to observation.

Conclusions:

• Patients with sphenoid sinus fractures require careful examination for TON.
• Steroid therapy at this institution leads to more rapid visual improvement and better final visual acuity in TON patients compared to observation.