It can be classified depending on the site of injury optic nerve head, intraorbital, intracanalicular, or intracranial or according to the mode of injury direct or indirect. Traumatic optic neuropathyassociated progressive thinning of. Indirect traumatic optic neuropathy military medical research. Visual outcome of traumatic optic neuropathy in patients. The aim of this article is to evaluate current literature on investigation and management of traumatic optic neuropathy ton, propose recommendations for diagnosis and management, and explore novel future treatments. Traumatic optic neuropathy treatment trial tontt full. Sep, 2018 the main treatment options for traumatic optic neuropathy ton include systemic corticosteroids and surgical optic nerve decompression, either alone or in combination. Traumatic optic neuropathy is an uncommon but often devastating cause of permanent visual loss after blunt or penetrating injury.
Indirect traumatic optic neuropathy military medical. Since the early 1980s, steroids have been used in an attempt to reduce the abnormal swelling that follows an injury to the optic nerve and improve visual recovery. Endoscopic optic nerve decompression has been suggested to be effective in treating this condition. The optic nerve axons may be damaged either directly or indirectly and the visual loss may be partial or complete. Indirect damage to the optic nerve is the most common form of traumatic optic neuropathy, occurring in 0. Traumatic optic neuropathy ton is commonly associated with head trauma, and thus is a known comorbidity of traumatic brain injury tbi. Epidemiology traumatic optic neuropathy occurs in 0. The data offered in the article by rajiniganth et al 1 do not support the assertion that patients with traumatic optic neuropathy must be treated with a combined therapy protocol for a better visual outcome. Traumatic optic neuropathy ton is a condition in which acute injury to the optic nerve from direct or indirect trauma results in vision loss. Pdf we present a case of acute traumatic optic neuropathy in 54 year old male patient. Traumatic optic neuropathy is frequently associated with loss of consciousness, but sometimes occurs with only minor injury to the periorbital area. Clinical features of ton include vision loss, dyschromatopsia, visual field defects and a relative afferent pupil defect except in the case of a symmetric bilateral ton.
Mohamed elshikh, irfan masood, woolridge n, heymann j. Since the early 1980s, steroids have been used in an attempt to reduce the abnormal swelling that follows an injury to. Injuries, classified as direct or indirect, are also characterized by location. Traumatic optic neuropathy ton refers to an acute injury of the optic nerve secondary to trauma. Pdf diagnosis of traumatic optic neuropathy jiachen. The causes of ton are thought to be multifactorial. Today, for a number of reasons, treatment of any resulting blindness or severe visual impairment due to a traumatic injury is usually secondary to treatment of the immediate. To prevent a poor outcome, aggressive management is required. The diagnosis can be made with accurate history taking and clinical examination, based on the presence of visual loss with accompanying loss of color vision and possible visual field defects and an accompanying relative afferent. None of the patients had evidence of optic nerve compression on ct scans or mri done. Direct traumatic optic neuropathy ton is a devastating condition and clinical challenge. Traumatic optic neuropathy ton refers to optic nerve injury resulting from direct and indirect head and facial trauma. If you continue browsing the site, you agree to the use of cookies on this website.
Review and analysis of the literature are complicated by the variety of therapeutic approaches and a lack of randomized, controlled studies on the use of these modalities for ton. Steroids in the treatment of traumatic optic neuropathy. Surgical treatment of progressive visual loss in traumatic optic neuropathy. Traumatic optic neuropathy ton can lead to profound visual loss from either indirect or direct mechanisms. This impact may create a shock wave which can lead to optic nerve avulsion or posterior indirect traumatic optic neuropathy.
Traumatic optic neuropathy ton refers to any insult to the optic nerve secondary to trauma. The treatment of traumatic optic neuropathy includes keeping the patients under observation, administering corticosteroid therapy, or performing optic nerve decompression with or without steroid therapy. Traumatic optic neuropathy ton is an important cause of severe visual loss following blunt for penetrating head and facial trauma. The natural history of traumatic optic neuropathy has not been studied prospectively, but several authors have reported that spontaneous recovery may occur in at. Here, we reported longitudinal changes in the peripapillary retinal nerve fiber layer rnfl and macular ganglion cell complex gcc using widefield swept source optical coherence tomography ssoct in two cases of. Laceration and compression of the optic nerve comprised 10% and 6. Highdose corticosteroids for traumatic optic neuropathy will result in a measurable loss of life in patients who also have a brain injury.
Ton, though uncommon, causes substantial visual loss. In indirect ton cases, the injury to the axons is thought to be induced by shearing forces that are transmitted to the fibers or to the vascular supply of the nerve. The pathophysiology of traumatic optic neuropathy ton is thought to be multifactorial, and some researchers have also postulated a primary and secondary mechanism of injury. Traumatic brain injury is one of the leading causes of disability and mortality in the united states. Hyperbaric oxygen hbo2 therapy has been proposed as an adjunctive treatment for eye disease but has rarely been used in optic neuropathy. Posterior lesions, on the other hand, are often free of ophthalmoscopic findings, but disc edema acutely and optic nerve pallor eventually do occur. Treatment of ton is divided primarily into two categories. The natural history of traumatic optic neuropathy has not been studied prospectively, but several authors have reported that spontaneous recovery may occur in at least a third of patients. It can be classified depending on the site of injury. According to a study by ansari2, in which a total of 2,503 patients were enrolled, retrobulbar hemorrhage was thought to be the primary mechanism of blindness, followed by direct damage to the eyeball. Traumatic optic neuropathy can be treated by various methods including steroids and surgical decompression. Clinical treatment of traumatic optic neuropathy in children.
Benefit of hyperbaric oxygen therapy treatment in direct. Loss of vision eyesight restore after eye or head trauma. Traumatic optic neuropathyclinical features and management. The patient presented with acute loss of vision in the right. Needless to say, it has formed the topic of much debate in the past, especially with regard to its surgical management. Traumatic optic neuropathy ton is an acute injury of the optic. Apr 25, 2020 there is no standard of care regarding the choice to use or not use optic canal decompression or corticosteroids in the treatment of traumatic optic neuropathy. Death has never been an endpoint for traumatic optic neuropathy studies. Management of traumatic optic neuropathy levin, leonard a. A great deal of controversy surrounds the physiology and management of traumatic optic neuropathy.
Traumatic optic neuropathy often results in severe visual loss and the vast majority of affected people are young males in their thirties. Mar 01, 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. At 6 months of fol wup, ther isk d a g n s t e roid g uph an l c b. Pdf diagnosis of traumatic optic neuropathy stuart. Ms traumatic optic neuropathy ton is a form of optic neuropathy typically caused by indirect optic nerve injury resulting in dramatic impairment of visual function accompanied by an ipsilateral relative afferent pupillary defect marcusgunn pupil. Traumatic injury of varying degrees of severity can damage the optic nerve and cause vision loss that only reverses itself in about onethird of the known cases. T raumatic optic neuropathy ton is an uncommon but devastating cause of permanent visual loss following blunt force trauma to the orbit. Pdf diagnosis of traumatic optic neuropathy jiachen zhuo. The incidence of traumatic optic neuropathy has shot up due to rapid increase in the number of vehicles on road.
Traumatic optic neuropathy ton is an acute injury of the optic nerve secondary to trauma. Connecting endoplasmic reticulum and oxidative stress to. The international optic nerve trauma study ionts represents the largest, most unbiased study of traumatic optic neuropathy to date, and points to far different conclusions. Pdf traumatic optic neuropathy to treat or to observe. Treatment of traumatic optic neuropathy remains controversial. Traumatic optic neuropathy is visual loss caused by trauma to the optic nerve. Traumatic optic nerve damage after craniofacial injury was first described by hippocrates. The optic nerve on was hyperintense on dwi and hypointense on adc map indicating traumatic optic nerve neuropthy ton figure 2c received. Traumatic optic neuropathy ton describes an injury to the optic nerve following either blunt or penetrating trauma. Clinical treatment of traumatic optic neuropathy in. Ton has not received much attention in basic research despite being associated with permanent vision loss, color blindness, and loss of visual fields. The most common site of indirect optic nerve injury is the optic. Indirect injuries are caused by forces that are transmitted at different levels after blunt head trauma.
While projectiles or other sharp objects injure the optic nerve directly, the most common form of traumatic optic neuropathy is indirect, as a result of concussive force to the head, particularly the forehead. Short report visual prognosis after indirect traumatic. Short report visual prognosis after indirect traumatic optic. Sep, 2018 traumatic optic neuropathy ton refers to an acute injury of the optic nerve secondary to trauma. Indirect traumatic optic neuropathy iton refers to optic nerve injury resulting from impact remote to the optic nerve. Traumatic optic neuropathyassociated progressive thinning. Visual prognosis after indirect traumatic optic neuropathy. Nov 25, 2014 the aim of this article is to evaluate current literature on investigation and management of traumatic optic neuropathy ton, propose recommendations for diagnosis and management, and explore novel future treatments. Clinical features and treatments for traumatic optic neuropathy ton.
Most data concerning this condition comes from case series of civilian patients suffering blunt injury, such as from sports or motor vehiclerelated. The aim of this study was to assess the outcome of treating traumatic optic neuropathy with steroids and endoscopic surgical decompression. Indirect traumatic optic neuropathy iton is a condition in which a patient suffers head trauma and is found to have reduced vision and an afferent pupillary defect despite a normal acute slit lamp examination and normal acute magnetic resonance imaging mri and computer tomography ct of the optic nerve and canal. Traumatic optic neuropathy ton is a form of optic nerve injury that occurs secondary to trauma and is etiologically associated with acute axonal loss with severe vision loss. Aug 21, 2015 traumatic optic neuropathy dr arpita slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Although the majority of patients are young adult males, about 20% of cases occur during childhood.