Visual prognosis after indirect traumatic optic neuropathy

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.

European Journal of Ophthalmology, 2006

To report the long-term outcome of patients with indirect traumatic optic neuropathy (TON) which showed useful vision for a short period after trauma. METHODS. A cohort of 12 TON patients treated with steroids megadose immediately after trauma was followed every 6 months for an overall period of 5 years. Other than a full neuro-ophthalmologic examination, each visit included quantitative Goldmann perimetry and pattern reversal visual evoked potentials. The results of each examination were compared with the visual function at baseline. The main outcome measures were visual acuity and visual field. Data were analyzed using the Wilcoxon signed-rank test. A p value of less than 0.05 was considered statistically significant. RESULTS. All patients showed a stable visual function 5 years after optic nerve trauma. There was no difference in visual acuity levels (p=0.65) and no visual field surface area between the visit at baseline and the last follow-up. However, a significant improvement in visual field extension (p=0.036) was observed after perimetry evaluation. CONCLUSIONS. This cohort of patients clearly demonstrates that the residual visual function found in the short term after TON is maintained for at least 5 years. These findings add further important clinical information for patients with TON. Furthermore, these data may be helpful to better quantify morbidity related to optic nerve trauma and its permanent sequelae.

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 ...

Aim: To Analyse The Various Prognostic Factors Which Will Influence The Visual Outcome In

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...

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.

IP innovative publication pvt. ltd, 2019

Introduction: Head injury accounts for approximately 3.4% of all emergency presentations. The role of ocular injuries secondary to head trauma in the causation of blindness continues to be an immense public health problem. This study is aimed to estimate the incidence of traumatic optic neuropathy, to obtain demographic data and to document concurrent injuries in cases of head injury. Materials and Methods: A total of 510 patients presenting with head injury were examined for all the ocular injuries. Severity of head injury which was graded according to Glasgow Coma Scale (GCS). Computed tomography (CT) scan of head was done in all the patients. Visually evoked potential (VEP) was done in patients who had relative afferent pupillary defect (RAPD) and defective color vision. Diagnosis of traumatic optic neuropathy was confirmed on the basis of VEP. Results: Majority of the people affected were males (77.5%). Patients between 16-45 years were affected most. The most frequent site of injury was roadside (72.55%). Ophthalmic involvement was observed in 313 individuals (61.4%). Abnormal uni-ocular color vision was found in 21(4.11%) patients. RAPD was found in 24 (4.70%) patients. VEP was abnormal in 10 (1.96%) patients, of all the cases of head injury. Conclusion: There was a 1.96% incidence of traumatic optic neuropathy in patients of head injury. Among all the ocular findings, eyelid ecchymosis with edema was most common. Intracranial hemorrhage was the most common CT scan finding in head injury patients. Chances of ophthalmic manifestations are much more when there is intracranial bleeding and facial fractures. Keywords: Traumatic optic neuropathy, Head injury.

Neuro-Ophthalmology, 2014

Traumatic optic neuropathy (TON) refers to an acute injury to the optic nerve secondary to ocular trauma. The study was conducted to evaluate the visual outcome in cases of TON and to study reversal of optic nerve function after emergency ophthalmic intervention. Objectives: To evaluate the visual outcome in cases of TON, study the factors affecting final visual outcome and to evaluate the optic nerve function in cases of TON. Methodology: The present study was a Prospective observational study, 49 patients presented after ocular trauma in the