traumatic_optic_neuropathy

Traumatic optic neuropathy

Traumatic optic neuropathy (TON) is a serious complication of craniofacial trauma that directly or indirectly damages the optic nerve and can cause severe vision loss. The incidence of TON has been gradually increasing in recent years. Research on the protection and regeneration of the optic nerve after the onset of TON is still at the level of laboratory studies and is insufficient to support the clinical treatment of TON. And, due to without clear guidelines, there is much ambiguity regarding its diagnosis and management. Clinical interventions for TON include observation only, treatment with corticosteroids alone, or optic canal decompression (with or without steroids). There is controversy in clinical practice concerning which treatment is the best 1).

Traumatic optic neuropathy treatment.

A case of acute traumatic optic neuropathy in 54 year old male patient. The patient presented with acute loss of vision in the right eye due to a blunt trauma to the eye. Lid haematoma and subconjunctival hemorrhage were present. Fluorescein staining was negative, anterior chamber and lens was clear. Intraocular pressure was normal. Retina and optic nerve head appeared normal on fundoscopy. The vision was “counting fingers at 1 meter” in the right eye. Color test indicated color perception dysfunction of the right eye. Relative afferent pupillary defect (RAPD) was positive. Ocular ultrasound, orbital X ray and CT scan was normal, but visual evoked potentials test was pathologic. The consideration was made whether to treat a patient or not since there are no consensus on the treatment of traumatic optic neuropathy. We decided to treat the patient immediately with the megadoses of steroids following the protocol suggested by Cerovski. The patient responded well to the treatment and recovered vision to normal 2).


1)
Chen B, Zhang H, Zhai Q, Li H, Wang C, Wang Y. Traumatic optic neuropathy: a review of current studies. Neurosurg Rev. 2022 Jan 16. doi: 10.1007/s10143-021-01717-9. Epub ahead of print. PMID: 35034261.
2)
Samardzic K, Samardzic J, Janjetovic Z, Samardzic I, Sekelj S, Latic-Hodzic L. Traumatic optic neuropathy - to treat or to observe? Acta Inform Med. 2012 Jun;20(2):131-2. doi: 10.5455/aim.2012.20.131-132. PMID: 23322966; PMCID: PMC3544324.
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  • Last modified: 2022/01/17 13:37
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