Indirect traumatic optic neuropathy in a high-risk diabetic adolescent: A rare clinical presentation

Indirect traumatic optic neuropathy (ITON) is a rare but severe complication of craniofacial trauma. Its management remains controversial, ranging from high-dose corticosteroids and surgical decompression to observation. Comorbidities may significantly impact therapeutic decision-making. We report the case of a 16-year-old male patient with poorly controlled type 1 diabetes (HbA1c = 11%) who sustained a road traffic accident with craniofacial trauma. On day 3, he developed acute visual loss in his right eye. Imaging revealed a right zygomatic tripod fractures without ocular involvement and optic nerve elongation on Magnetic resonance imaging (MRI), consistent with ITON. This case highlights a dramatic therapeutic dilemma: attempting to preserve vision at the cost of significant systemic risks. The rarity of ITON in young patients and the absence of specific guidelines for diabetic patients, make decision-making particularly challenging. Multidisciplinary discussion; Ophthalmology, maxillofacial surgery, endocrinology, intensive care was crucial. The management of ITON in patients with uncontrolled diabetes raises critical therapeutic, prognostic, and ethical issues. This case emphasizes the need to tailor treatment strategies and carefully weigh comorbidities in the risk-benefit balance.