Traumatic optic neuropathy after head injury

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.

Background: Optic nerve injuries occur in the setting of head injury which is often a consequence of road traffic accidents or falls. Traumatic optic neuropathy (TON) is a potentially blinding complication of head and orbital trauma. Different treatment approaches like different dosages of steroids, surgical decompression and observation alone have been suggested but there is no standardized protocol till date. Object: To study the clinical profile, risk factors, visual outcome in a series of forty five patients of Traumatic Optic Neuropathy (TON) after medical management at our tertiary centre. Methods: Forty five patients reported to outpatient department from January 2018 to June 2019 who have a history of trauma were studied prospectively. After relevant and detailed ocular examination, Intravenous methyl prednisolone 1 gram for 5days and thenoral prednisolone 1 mg/kg in tapering doses for two weeks was administered in all patients irrespective of duration of presentation to the hospital after trauma. Results: The age group involved was predominantly 16 to 45years (80%) with a mean age of 35.31 years. Range of follow up was seen from 5days to 5 months. Males (91%) were outnumbered. Road traffic accidents (73.33%) were found to be the most common cause for TON in our series. Of 45, 10 patients were lost to follow up, rest 35 patients who have been followed steroid regime, 18 (51.43%) showed visual improvement (12 patients had >/=2 line improvement, rest 06 patient had one line improvement). 17(48.57%) patients did not show any improvement. 08 patients were same (no perception of light) till the final follow up. Conclusion: IV methyl prednisolone along with oral steroids as proposed by ONTT has been found effective in our case series of TON even in patients who have very low initial visualacuity and who presented late even after 24 hours of injury till the irreversible damage to optic nerve.No major side effects have been encountered with this steroid regimen. High dose steroid has proven its role in traumatic optic neuropathy.

International journal of ophthalmology, 2010

To evaluate the clinical presentations of traumatic optic neuropathy and to assess the visual outcome of three groups of patients managed differently (conservative, intravenous corticosteroids only and combination of intravenous and oral corticosteroids) at an academic tertiary care referral centre. A retrospective study was conducted involving 24 consecutive patients (27 eyes) with traumatic optic neuropathy attending Hospital Universiti Sains Malaysia from January 2007 till December 2009. Twenty-four patients (27 eyes) were included. All cases involved were males. Mean age was 33 years old. Motor vehicle accident was the major cause (83.3%). Both eyes were equally involved. Most of the eyes had poor vision on presentation (HM-NPL, 81.5%) with associated periorbital haematoma (22 eyes) and subconjunctival haemorrhage (20 eyes). Majority of patients (19 patients, 79.2%) presented with more than one bony fracture of skull or orbit and 5 patients (20.8%) had no fractures. None of the ...

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.

Indian Journal of Neurotrauma, 2021

Objective Traumatic optic neuropathy (TON) is an important cause of severe vision impairment after sustaining a closed head injury. This study describes the safety and efficacy of combined therapy in the management of TON. Methods A retrospective analysis of 23 consecutive cases of unilateral TON managed with combined therapy (steroid and surgery) were performed. Statistical analysis of patient characteristic, timing of vision loss, radiological and intraoperative findings, and pre- and post-treatment vision were compared to assess the prognostic factors. Results Seventeen patients (85%) had vision improvement with combined therapy. Three patients (15%), who recorded no improvement, initially presented with no perception of light, and loss was sudden and immediate. With steroids, 9 patients improved, all of them presented with perception of light (PL) or better and vision improved to (6/6 in five, 6/9 in one, 6/18 in 3). Eleven patients (6 PL–ve and 5 PL + ve after failed steroid th...

Current Opinion in Opthalmology, 1999

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.

British Journal of Ophthalmology, 1992

Twenty three patients with traumatic optic neuropathy were managed by medical and surgical treatment as follows. High dose intravenous steroids were initiated in all patients. If visions did not improve significantly after 24 to 48 hours decompression of an optic nerve sheath haematoma by medial orbitotomy and neurosurgical decompression of the optic canal were considered based on computed tomographic scan findings. Nine of 16 patients who received steroids only showed significant improvement. One of three showed improvement on optic nerve decompression after steroid failure; three or four showed improvement with combined optic nerve sheath decompression by the medial orbitotomy and decompression of the optic canal by frontal craniotomy. A lucid interval of vision after injury and an enlarged optic nerve sheath were associated with an improved prognosis. Five of the 23 patients had a lucid interval and all five had a final improved vision, while only five of 18 patients without a lucid interval improved. Similarly seven of the nine with an enlarged optic nerve sheath showed improvement while only three of 10 patients (three bilateral cases) who presented with no light perception improved with medical and surgical treatment. While a prospective controlled study of the management of traumatic optic neuropathy is necessary this preliminary study suggests that treatment of traumatic optic nerve sheath haematoma by optic nerve sheath decompression should be considered in selected patients.

PURPOSE:In a case of trauma, loss of vision due to traumatic optic neuropathy is a feature for which patients present late due to initial multisystem injury and serious brain injury.Therefore, the objective of the study is to find the time lag and causes of delayed presentation in patients with traumatic optic neuropathy due to RTA.OBSERVATION: It is a hospital basedcase series in which 37 patients with Traumatic Optic Neuropathy were considered. Diagnosis of Traumatic Optic Neuropathy was based on history of RTA, diminution of vision, impaired colour vision, RAPD and/or disc pallor. A questionnaire with questions to know the time of injury, associated multisystem morbidities, reason for delay in presentation was administered.Delay in presentation was defined as presentation more than 3 days following trauma.RESULTS: Traumatic Optic Neuropathy is significantly seen more in men (97%).Median time lag was 13 days.More the time lag worse is the visual acuity at presentation. Median time lag in PL negative group was 24days, PL + or more was13 days, no visual complaints was 4.5 days. Most common reason for delay was loss of consciousness (43%). CONCLUSION: As seen by our study the time lag is more (24 days) in patients with PL negative vision.Hence a referral to ophthalmologist at earliest is of utmost importance. Also creating awareness that head trauma can lead to loss of vision and motivating head trauma patients to consult ophthalmologist as early as possible for early diagnosis and treatment is also important.

Neuro-Ophthalmology, 2017

This study aims to report the clinical features and role of different treatment modalities in final visual outcome in traumatic optic neuropathy (TON). The authors retrospectively reviewed the records of patients with TON over 4 years. There were 37 patients of unilateral TON. Mean age was 28.70 ± 15.20 years (range: 8-90) and 89% (n = 33) were males. Road traffic accident was the common cause (43.2%), followed by fall injury (35.1%). There was improvement of visual acuity in 51.4% (n = 19) cases. Out of different treatment modalities, high-dose intravenous methylprednisolone (1 g/day) led to significant improvement in final visual acuity (p = 0.013). There was no significant improvement in final visual outcome in patients with poor initial visual acuity and those with intracranial injuries.