A Case Series on Traumatic Optic Neuropathy

KESANS : International Journal of Health and Science, 2022

TON or traumatic optic neuropathy is a condition that can cause blindness which can be caused by trauma to the orbital area or head trauma. In its classification, TON is divided into two, namely direct and indirect. Direct TON or direct TON, is usually caused by a decrease or loss of a person's visual ability and the chance of recovery is smaller than indirect TON. This direct TON usually occurs when the optic nerve is laced with surrounding bone or the cause can be anatomical structural abnormalities. TON treatment can be done in two ways (1) Treatment with high doses of corticosteroids (2) with surgery.

Neuro-Ophthalmology, 2014

Current Opinion in Opthalmology, 1999

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...

Eye, 2010

Aims The aim of this study is to provide epidemiological data on the incidence, aetiology, management, and visual outcome in traumatic optic neuropathy (TON) in the UK. Methods Patients with TON were identified prospectively by population-based active surveillance through the British Ophthalmic Surveillance Unit over a 2-year period with data obtained from an incident questionnaire and follow-up questionnaire sent to positive reporters. Results Incident and follow-up data were available on 121 and 97 (80%) patients, respectively. The minimum estimated incidence was 1.005 per million. Leading causes included falls (25.6%), road traffic accidents (RTAs) (21.5%), and assaults (20.7%). The median age was 31 years. There were 95 (78.5%) men. Presenting visual acuity (VA) was 6/60 or worse in 85 (70%) patients, with 43 patients (36%) with no perception of light. Associated injuries included 47 (39%) orbital wall fractures, 37 (31%) closed globe injuries, 23 (19%) ocular adnexal injuries, 23 (19%) skull fractures, and 18 (16%) intracranial bleeding. Sixty-five percent (75/116) received no acute treatment and 35% (41/116) received steroids and/or surgery. Of the treated group, 24% (8/ 33) and of the untreated group 20% (11/56) improved three lines or more of VA (P ¼ 0.61). Prompt ophthalmic examination (P ¼ 0.002), orbital fracture (P ¼ 0.046), high Glasgow Coma Scale (GCS) score (P ¼ 0.023), and poor initial VA (P ¼ 0.009) were associated with increased likelihood of treatment. Poor initial VA (Po0.001), orbital fracture (P ¼ 0.004), and significant head injury (P ¼ 0.038) were associated with poor visual outcome. Conclusions This study suggested that young men were at greatest risk of TON. We detected a trend towards conservative management of this condition in the UK. TON was associated with significant ocular, orbital, and head injuries that highlighted the need for multidisciplinary management.

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

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.

JAMA ophthalmology, 2014

Current controversy about the primary treatment of traumatic optic neuropathy (TON) has anchored on final vision following injury, but, to our knowledge, no study has examined the effect of different treatments on regaining and protecting optic nerve reserve or on the outcome of second optic nerve injuries. To assess vision improvement in patients treated by various methods who have a second incidence of TON. Retrospective medical record review of 12 patients with a second TON seen in an 18-year period (mean follow-up, 11.3 months) at a single tertiary care oculoplastic practice. Observation, high-dose corticosteroids, optic nerve decompression, or high-dose corticosteroids plus optic nerve decompression. Change in vision on the Snellen eye chart. RESULTS All second TON events involved the same-side optic nerve as initially injured, and with observation alone, corticosteroids, or corticosteroids and partial optic canal decompression, all patients had vision improvement after their i...

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.