Surveillance of traumatic optic neuropathy in the UK

Research Square (Research Square), 2023

Background: Traumatic optic neuropathy (TON) is a rare condition with serious consequences. One common cause of TON is orbital wall fracture, which can occur at any site. This study aimed to report the incidence of TON in orbital wall fractures. Materials and Methods: A systematic search of Medline, Scopus, and the Directory of Open Access Journals (DOAJ) was conducted. The following terms were used: (traumatic optic neuropathy OR blindness) AND (craniofacial trauma OR facial fractures OR fracture pattern OR orbital wall fracture OR Visual eld orbital wall fractures) AND (Visual acuity OR Visual evoked potential) AND (Mega-dose steroid therapy OR corticosteroids). This review encompassed both Randomized Controlled Trials (RCTs) and observational investigations, comprising both prospective and retrospective studies. Results: Four studies met our inclusion criteria with 2720 patients included in this study. Most of the patients were males (n = 2175, 80%). A total of 3791 orbital wall fracture subtypes were reported in the included patients. Of them, 1522 patients had multiple fractures. The highest incidence of fracture was oor fracture, with an Event Rate (ER) of 42.2%, followed by lateral fracture (ER = 37.9%), roof fracture (ER = 36.2%), and medial fracture with ER (29%). Motor vehicle accidents were the most common injury mechanism reported in 46 patients, compared with traumatic injuries reported in 23 patients. Conclusion: Lateral and superior orbital wall fractures were the most common orbital fractures in patients with TON. Periorbital hematoma and subconjunctival hemorrhage were the most frequently reported complications. Hence, ophthalmologists treating patients with TON should prepare radiological assessments and consider the surrounding structures to prevent damage to other structures.

Neuro-Ophthalmology, 2014

The Open Ophthalmology Journal, 2023

To report the aetiology, visual outcome, and clinical features of indirect traumatic Optic Neuropathy (TON) patients from the tertiary eye care center in South India. Methods: It is a retrospective and observational study. Details of age, gender, number of days of presentation after injury, Snellen visual acuity at presentation and last follow-up, visual evoked potentials, visual field findings using the Humphrey visual field analyser, associated ocular complications, and mode and time of treatment were obtained from the medical records of all indirect TON patients. Results: Indirect TON patients are mainly young males (94%) and road traffic accident (RTA) (65%) is the main cause of TON, followed by falls (19%) and sport-related activities (11%). Visual acuity loss was severe in more than 50% of the subjects and only 16%% of the patients showed improvement in visual acuity greater than one line. Pattern visual evoked potentials and visual fields are recordable only in 15% of the subjects. Commonly associated ocular complications in indirect TON patients were orbital fracture (43%), lid tear (16%), sub-conjunctival haemorrhage (13.5%), and angle recession (13.5%). Three out of four patients who received methylprednisolone and oral steroids within a week showed an improvement in visual acuity of greater than three lines, while just one patient out of four who received the same medication after a week improved visual acuity of three lines. Conclusion: RTA (road traffic accidents) is the most common cause of indirect TON and mainly young males were the affected individuals. IVMP along with oral steroids within a week, would help TON patients for reasonable visual recovery. Presenting Visual acuity of > 6/600 and recordable pattern VEPs would be the prognostic factors for good visual outcomes in indirect TON patients.

Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2017

Intravenously administered erythropoietin (EPO) was firstly commenced (phase 1) in patients with indirect traumatic optic neuropathy (TON) by this group in 2011. It was re-tested by another group (phase 2) in 2014. This multicenter clinical trial was designed to compare its effect with intravenous steroid and observation. Included were TON patients ≥5 years of age and with trauma-treatment interval of ≤3 weeks. Follow-up visits were set at 1, 2, 3, 7, 14, 30, and at least 90 days after treatment. EPO and methylprednisolone were infused intravenously every day for three consecutive days. Primary outcome measure was change in the best corrected visual acuity (BCVA). Secondary outcomes included change in color vision and relative afferent pupillary defect (RAPD), side effects, and factors affecting the final visual improvement. Out of 120 patients, 100 (EPO: 69, steroid: 15, observation: 16) were finally included. All three groups showed a significant improvement of BCVA which was not ...

Orbit, 2014

In our prospective nationwide surveillance study of traumatic optic neuropathy (TON) in the United Kingdom, the prevalence of orbital fractures was found to be 39% (47/121). The prevalence of skull fractures was 7.4% (9/121). This study aims to identify the association of craniofacial-orbital fractures with the severity of visual loss. TON patients who sustained orbital fractures were identified prospectively by population-based active surveillance through the British Ophthalmic Surveillance Unit over a 2-year period. Available CT scans were classified by a head and neck radiologist according to the Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) scheme: the face was divided into 4 units; fractures in each unit were graded according to displacement (A-C) and severity (1.1-3.3). Correlation between severity of craniofacial orbital fractures and visual acuity as well as number of fractured units and visual acuity were evaluated. Twelve of the 25 patients (48%) with imaging available had adequate high resolution craniofacial CT imaging for review and classification using the AO/ASIF system (i.e. 48 classifiable units). Three of 48 (6%) units were undisplaced (grade A), 18 of 48 (29%) units were minimally displaced (grade B), and 4 of 48 (8%) units had largely displaced (grade C) fractures. Twenty-three units (47.9%) had no fractures; 5 patients had radiological evidence of optic canal fractures. Poor visual acuities positively correlated with severity of fractures graded using the AO/ASIF classification (Spearman's rho = 0.95, p = 0.05) and number of fractured units (Spearman's rho = 1.0, p < 0.0001). AO/ASIF classification system provides a uniform method in the assessment of orbital fractures which correlates with visual outcome in TON.

IOSR Journals , 2019

BACKGROUD: Traumatic optic neuropathy (TON) refers to an acute injury of the optic nerve secondary to trauma. The optic nerve axons may be damaged either directly or indirectly and the visual loss may be partial or complete. Optic nerve decompression with steroids or surgical interventions or both has therefore been advocated as a means of improving visual prognosis in TON.OBJECTIVES:The aim of the study is to retrospectively analyse the most common cause ,age group ,gender,fracturerate,presenting visual acuity and postmedicaltreatment visual acuity.METHODS: Inclusion criteria:isolated traumatic optic neuropathy with atleast one follow up visit.A retrospective study of 50 patients with isolated traumatic optic neuropathy with atleast one followup was done.They were given iv methylprednisolone,iv steroids and oral steroids and tab.methycobalamine based on severity at the time of presentation.RESULTS:Most common gender affected were males(98%) than females.Most common age group was 33yrs(range 4yrs to 66yrs) and cause was roadtraffic accident around 81.6%,fracture rate about 53%.Left eye was most commonly affeceted (around 60.4%).22% presented with vision with No PL,24% from PL+ to ( ½)/60,20% with vision 1/60 to 5/60,27% presented with vision ranging 6/60 to 6/9,6% with 6/6.Post treatment vision ranged:10%-NO PL,24%-PL+ to (½)/60,24%-1/60 to5/60,18%-6/60 to 6/9,22%-6/6

Innovative Publication, 2016

Purpose: To study the clinical profile, prognostic factors and the effect of systemic steroids in the management of traumatic optic neuropathy. Materials and Method: A minimum of forty four patients with closed head injury with complaints of any of the following: decreased visual acquity following trauma, RAPD, defective colour vision, visual field defects or CT scan showing fracture of any orbital wall were selected randomly and detailed ocular examination was done. Patients were treated with IVMP. Results: Patient age ranged from 11-69 years. The causes of head injury were road traffic accidents (86.4%), accidental falls (9.1%), and assault (4.5%). Majority of patients were male (93.18%). Unilateral involvement was seen in 95.45% cases. 61.36% cases were drowsy, 36.36% cases conscious and 2.27% cases were unconscious after the injury. In this study 34.78% of patients had profound loss of vision PL+ or HM (hand movements) as the initial vision. 13.04% cases had a visual acquity 6/18 or better. In 43.47% cases extraocular movements were restricted. RAPD was present in 95.5% of eyes. 82.60% of patients presented with sub conjunctival hemorrhage. CT scan coronal view showed optic nerve sheath thickening in 17.39% patients. The most common fractures noted were fracture floor of orbit in 23.19% cases and medial wall of orbit in 15.21% cases. 38 patients were treated with intravenous Methyl prednisolone within 24-72 hrs. of suspicion of traumatic optic neuropathy. Initial ophthalmoscopic examination was conducted on 46 eyes and optic disc was normal in all cases except one who showed mild disc edema. In 6 to 12 weeks more than 50% optic discs became pale. Optic disc pallor developed in about 81.5 % cases in 6 months. In the present study out of six; 5 patients showed spontaneous improvement without treatment, but treated patients appeared to have a better visual acuity and visual fields. Conclusion: Road traffic accidents were the most common cause associated with TON and males being more commonly involved. Treated patients had a better visual prognosis. On follow up, it was noted that visual acuity improved in patients who had initial vision more than light perception and in patients with no optic canal fractures.

Acta Clinica Croatica

Traumatic optic neuropathy (TON) is a serious vision threatening condition that can be caused by ocular or head trauma. Indirect damage to the optic nerve is the most common form of TON occurring in 0.5% to 5% of all closed head trauma cases. Although the degree of visual loss after indirect TON may vary, approximately 50% of all patients are left with 'light perception' or 'no light perception' vision, making TON a signifi cant cause of permanent vision loss. We present a 47-year-old male patient with a history of right eye keratoconus following a motorcycle crash. Visual acuity was of 'counting fi ngers at 2 meters' on the right eye due to keratoconus and 'counting fi ngers at 1 meter' on the left eye as a consequence of trauma. Th e Octopus visual fi eld showed diff use reduction in retinal sensitivity and the Ishihara color test indicated dysfunction of color perception on the left eye. Relative aff erent pupillary defect was also present. Computed tomography revealed multifragmentary fracture of the frontal sinus and the roof of the left orbit without bone displacement. Based on the fi ndings, conservative corticosteroid therapy without surgery was conducted. Th e patient responded well to treatment with complete ophthalmologic recovery.

Current Opinion in Opthalmology, 1999

IP International Journal of Ocular Oncology and Oculoplasty, 2018

Aim: To study the clinical profile and outcome of traumatic optic neuropathy in a tertiary care eye center of India. Materials and Methods: This prospective study was conducted in 24 eyes of 22 consecutive patients with traumatic optic neuropathy who attended the outpatient ophthalmology department of a tertiary health care center of India from January 2014 to December 2016. The patients were equally divided into 2 groups. Those patients treated with intravenous methylprednisolone with a dose of 1gmfor 3 days followed by oral prednisolone with a dose of 1 mg/kg body weight for 11 days were included in group A and those observed with placebo treatment only were included in group B. Results: Twenty-one patients were males and only one patient was female. The most common age group was 21-30 years with mean age of 29.29 years. The causes of traumatic optic neuropathy were found to be motor vehicle accident (68.18%) followed by blunt trauma (22.72%) and fall (9.09%). Most of the eyes had the vision of hand movement to no perception of light on presentation (54.16%). The common extraocular associations were the periorbital hematoma (91.66%) and lid laceration (83.33%). Most of the patients (86.36%) were associated with multiple fractures of the skull and orbital bone and 13.63% of patients were not associated with any fracture. Eight of eleven patients (72.72%) in group A had shown 1 line improvement of visual acuity following treatment whereas six of eleven patients (54.54%) of Group B had shown 1 line improvement.The followup period of each patient in our study was 6 months. Conclusion: The common extraocular manifestations observed in our study were the periorbital hematoma, lid laceration, and bony fractures.Traumatic optic neuropathy in our study had a better visual outcome in steroid treatment group than those observed with placebo management.