Optic nerve trauma

Trauma to the optic nerve may be direct, such as from a penetrating object, or indirect, which may result despite lack of direct contact of an object with the nerve. Although indirect injury initially causes no change in the appearance of the nerve head, within a matter of weeks optic atrophy will be manifest. The pathophysiology of nerve damage is incompletely understood. Management is controversial; steroid therapy has been advocated, as has surgical decompression of the nerve. Indirect injuries affecting the optic nerve may also result from torsional rotation of the globe (avulsion) and from subdural or subarachnoid hemorrhage (Terson's syndrome). There is no treatment for optic nerve avulsion; the unaffected eye should be protected with appropriate eyewear. Hemorrhaging in the retina and vitreous in Terson's syndrome should be monitored for resolution and risk of retinal detachment. Computed tomography may be necessary if subarachnoid or intracranial hemorrhages are suspected.