[Monocular blindness following blunt head trauma]

An uncommon, devastating complication of blunt head trauma is monocular blindness. We present a 40-year-old man who complained of visual loss in the right eye a few days after minor closed head trauma. Electrophysiologic study (VEP) proved severe damage to the right optic nerve, most probably due to transection of the nerve. Based on the assumption that optic nerve injury might be analogous to spinal cord injury, we used methylprednisolone: a loading dose of 30 mg/kg was followed 2 hours later by 15 mg/kg, which was then given every 6 hours for 48 hours. Surgical decompression of the bony optic canal was not performed. There are no good data to guide our decision-making. A prospective randomized trial is required to provide definitive management guidelines in this severe and dramatic injury.