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Traumatic optic neuropathy-Clinical features and management issues

Lookup NU author(s): Dr Patrick Yu Wai Man


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© 2015.Traumatic optic neuropathy (TON) is an uncommon cause of visual loss following blunt or penetrating head trauma, but the consequences can be devastating, especially in cases with bilateral optic nerve involvement. Although the majority of patients are young adult males, about 20% of cases occur during childhood. A diagnosis of TON is usually straightforward based on the clinical history and examination findings indicative of an optic neuropathy. However, the assessment can be difficult when the patient's mental status is impaired owing to severe trauma. TON frequently results in profound loss of central vision, and the final visual outcome is largely dictated by the patient's baseline visual acuities. Other poor prognostic factors include loss of consciousness, no improvement in vision after 48 hours, the absence of visual evoked responses, and evidence of optic canal fractures on neuroimaging. The management of TON remains controversial. Some clinicians favor observation alone, whereas others opt to intervene with systemic steroids, surgical decompression of the optic canal, or both. The evidence base for these various treatment options is weak, and the routine use of high-dose steroids or surgery in TON is not without any attendant risks. There is a relatively high rate of spontaneous visual recovery among patients managed conservatively, and the possible adverse effects of intervention therefore need to be even more carefully considered in the balance.

Publication metadata

Author(s): Yu-Wai-Man P

Publication type: Review

Publication status: Published

Journal: Taiwan Journal of Ophthalmology

Year: 2015

Volume: 5

Issue: 1

Pages: 3-8

Print publication date: 01/03/2015

Online publication date: 17/02/2015

Acceptance date: 12/01/2015

ISSN (print): 2211-5056

ISSN (electronic): 2211-5072

Publisher: Elsevier


DOI: 10.1016/j.tjo.2015.01.003