A Systematic Literature Review on Traumatic Optic Neuropathy

Traumatic optic neuropathy (TON) is an uncommon vision-threatening disorder that can be caused by ocular or head trauma and is categorized into direct and indirect TON. The overall incidence of TON is 0.7–2.5%, and indirect TON has a higher prevalence than direct TON. Detection of an afferent pupillary defect in the presence of an intact globe in a patient with ocular or head trauma with decreased visual acuity strongly suggests TON. However, afferent pupillary defects may be difficult to detect in patients who have received narcotics that cause pupillary constriction and in those with bilateral TON. Mechanical shearing of the optic nerve axons and contusion necrosis due to immediate ischemia from damage to the optic nerve microcirculation and apoptosis of neurons is a probable mechanism. The proper management of TON is controversial. High-dose corticosteroid therapy and decompression of the optic nerve provide no additional benefit over observation alone. Intravenous erythropoietin may be a safe and efficient treatment for patients with TON.

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The Effects of High-Dose Corticosteroid Therapy on Optic Nerve Head Blood Flow in Experimental Traumatic Optic Neuropathy

Ophthalmic Research ◽

10.1159/000055572 ◽

1999 ◽

Vol 31 (6) ◽

pp. 463-470 ◽

Cited By ~ 12

Author(s):

Helen Lew ◽

Sang Yeul Lee ◽

Jae Woo Jang ◽

Hye Young Kim ◽

Shin Jeong Kang ◽

...

Keyword(s):

Blood Flow ◽

Optic Nerve ◽

Corticosteroid Therapy ◽

Optic Neuropathy ◽

Optic Nerve Head ◽

High Dose ◽

Traumatic Optic Neuropathy ◽

High Dose Corticosteroid ◽

Dose Corticosteroid

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Treatment of traumatic optic neuropathy with high-dose corticosteroid

American Journal of Ophthalmology ◽

10.1016/j.ajo.2006.05.016 ◽

2006 ◽

Vol 142 (1) ◽

pp. 203

Author(s):

K.D. Steinsapir

Keyword(s):

Optic Neuropathy ◽

High Dose ◽

Traumatic Optic Neuropathy ◽

High Dose Corticosteroid ◽

Dose Corticosteroid

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Mucormycoses: serious complication of high-dose corticosteroid therapy for traumatic optic neuropathy

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2007.09.177 ◽

2008 ◽

Vol 37 (4) ◽

pp. 391-394 ◽

Cited By ~ 9

Author(s):

I. Dojcinovic ◽

M. Richter

Keyword(s):

Corticosteroid Therapy ◽

Optic Neuropathy ◽

High Dose ◽

Traumatic Optic Neuropathy ◽

High Dose Corticosteroid ◽

Dose Corticosteroid

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Treatment of Traumatic Optic Neuropathy with High-Dose Corticosteroid

Journal of Neuro-Ophthalmology ◽

10.1097/01.wno.0000204646.94991.68 ◽

2006 ◽

Vol 26 (1) ◽

pp. 65-67 ◽

Cited By ~ 37

Author(s):

Kenneth D Steinsapir

Keyword(s):

Optic Neuropathy ◽

High Dose ◽

Traumatic Optic Neuropathy ◽

High Dose Corticosteroid ◽

Dose Corticosteroid

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Endoscopic optic nerve decompression in traumatic optic neuropathy: our experience in a tertiary care centre

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20214841 ◽

2021 ◽

Author(s):

Bincy Joseph ◽

Sapna S. Nambiar ◽

K. Ramachandran ◽

Suma Radhakrishnan

Keyword(s):

Visual Acuity ◽

Optic Nerve ◽

Optic Neuropathy ◽

High Dose ◽

Time Interval ◽

Traumatic Optic Neuropathy ◽

High Dose Steroid ◽

Nerve Decompression ◽

Prompt Treatment ◽

Optic Nerve Decompression

Background: Traumatic optic neuropathy (TON) a vision threatening disorder requires early diagnosis and prompt treatment. High dose steroid injections, optic nerve decompression or combined therapy are the available current treatment options. This study aims to determine the visual outcome with transnasal endoscopic optic nerve decompression in patients with TON having no improvement in vision despite high dose steroids.Methods: A prospective study was conducted at the department of ENT, government medical college Kozhikode; on patients who presented with loss of vision following history of trauma. All patients suspected of compressive optic neuropathy received injection methyl prednisolone (30 mg/kg/day) with assessment of vision and HRCT scan. Patients with deterioration or no improvement in vision despite high steroid therapy were taken up for trans-nasal endoscopic optic nerve decompression.Results: In our study 19 patients with TON underwent trans-nasal endoscopic optic nerve decompression. 11(57.9%) patients had improvement of vision, 7 (36.8%) patients had no improvement of vision and 1 (5.3%) patient had worsening of vision. The visual improvement was seen in 8 (80%) patients when treatment was initiated within 7 days and in only 3(33.3%) patients when treatment was initiated after 7 days. The visual acuity at presentation and time interval between trauma and intervention are factors that determine better visual outcomes.Conclusions: The decreased visual acuity in TON requires prompt treatment. High dose steroid must be started at once when it is suspected or diagnosed. The timely surgical intervention with trans-nasal endoscopic optic nerve decompression is a relatively safe and effective technique enabling better visual prognosis.

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Treatment of traumatic optic neuropathy: our experience of endoscopic optic nerve decompression

The Journal of Laryngology & Otology ◽

10.1017/s0022215108002296 ◽

2008 ◽

Vol 122 (12) ◽

pp. 1325-1329 ◽

Cited By ~ 30

Author(s):

H Li ◽

B Zhou ◽

J Shi ◽

L Cheng ◽

W Wen ◽

...

Keyword(s):

Optic Nerve ◽

Optic Neuropathy ◽

Visual Loss ◽

Vision Loss ◽

Surgical Decompression ◽

Traumatic Optic Neuropathy ◽

Improvement Rate ◽

Efficient Treatment ◽

Nerve Decompression ◽

Optic Nerve Decompression

AbstractObjective:Traumatic optic neuropathy can be treated by various methods including steroids and surgical decompression. Endoscopic optic nerve decompression has been suggested to be effective in treating this condition. The aim of this study was to assess the outcome of treating traumatic optic neuropathy with steroids and endoscopic surgical decompression.Methods:Two hundred and thirty-seven patients with traumatic optic neuropathy were treated with steroids; 176 also consented to endoscopic optic nerve decompression.Results:The total vision improvement rate was 55 per cent in the 176 patients treated with both steroids and endoscopic optic nerve decompression, compared with 51 per cent in the 61 patients treated with steroids alone; this difference was not statistically significant (p > 0.05). Treatment with steroids plus endoscopic optic nerve decompression resulted in a significantly greater vision improvement in patients with gradual vision loss, compared with those with immediate blindness (68 vs 42 per cent, respectively). Early surgery (within one week) was an important prognostic factor for vision recovery, compared with more delayed surgical treatment (associated vision improvement rates were 60 and 31 per cent, respectively).Conclusions:Endoscopic optic nerve decompression is a minimally invasive, safe and efficient treatment for traumatic optic neuropathy. Used in combination with steroids, it provides effective rescue for some patients suffering visual loss. It should be undertaken as soon as possible.

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