Abstract
Traumatic optic neuropathy (TON) is acute optic nerve injury secondary to ocular or head trauma which can lead to variable amount of visual loss. An effective management for traumatic optic neuropathy is still a challenge for an ophthalmologist. In majority of cases with poor prognostic factors, the visual outcomes may not be good once the diagnosis of TON has been made. There were several trials in past which were able to generate some evidence which guided the use of steroids, surgery or observation in TON. Though surgery, corticosteroids and conservative supportive management forms the mainstay of treatment for TON but there is inadequate evidence from clinical trials to support any specific treatment. Recent evidence also suggests a possible detrimental effect of steroids in TON. Each case therefore needs to be assessed on an individual basis and patient should be counselled before embarking on any mode of treatment.
Key Words: Traumatic optic neuropathy, ocular trauma, optic neuropathy.
References
- Steinsapir KD, Goldberg RA. Traumatic Optic Neuropathy: An Evolving Understa-nding. Am J Ophthalmol 2011;151:928-933
- Turner JWA. Indirect injury of the optic nerves. Brain 1943; 66:140-151.
- Russell WR. Injury to cranial nerves including the optic nerves and chiasma. In Brock S, ed. Injuries of the Skull, Brain and Spinal Cord. London, Bailliere, 1940:113-122
- Yu-Wai-Man P, Griffiths PG. Steroids for traumatic optic neuropathy. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD006032. DOI: 10.1002/14651858.CD006032.pub4
- Steinsapir KD, Goldberg RA. Traumatic optic neuropathy. SurvOphthalmol. 1994 May 1;38(6):487–518.
- Walsh FB: Pathological-clinical correlate-ions. I. Indirect trauma to the optic nerves and chiasm. 11. Certain cerebral involvem-ents associated with defective blood supply. Invest Ophthalmol5:433-449, 1966
- Alford MA, Nerad JA, Carter KD. Predictive value of the initial quantified relative afferent pupillary defect in 19 consecutive patients with traumat optic neuropathy. OphthalPlastReconstrSurg 2001;17:323-27
- Holmes MD, Sires BS. Flash visual evoked potentials predict visual outcome in traumatic optic neuropathy. Ophthal Plast Reconstr Surg. Sep2004;20(5):342-6.
- Flamm ES, Demopoulos HB, Seligman ML, et al. Free radicals in cerebral ischemia. Stroke 1978;9:445–7.
- Braughler JM, Hall ED. Effects of multidose methylprednisolone sodium succinate administration on injured cat spinal cord neurofilament degradation and energy metabolism. J Nurosurg 1984;61: 290–5.
- Braughler JM, Hall ED, Means ED, et al. Evaluation of an intensive methylpredni-solone sodium succinate dosing regimen in experimental spinal cord injury. J Neurosurg 1987;67:102–5.
- Bracken MB, Shepard MJ, Collins WF, et al. A randomized,controlled trial of methylprednisolone or naloxone in thetreatment of acute spinal-cord injury: results of the SecondNational Acute Spinal Cord Injury Study. N Engl J Med1990;322(20):1405-1411.
- Roberts I, Yates D, Sandercock P, et al. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomized placebo controlled trial. Lancet 2004;364:1321-8.
- Levin LA, Beck RW, Joseph MP, Seiff S, Kraker R. The treatment of traumatic optic neuropathy: the International Optic Nerve Trauma Study. Ophthalmology 1999;106 (7):1268-1277
- Sheng Y, Zhu Y, Wu L. Effect of high dosage methylprednisoloneon rat retinal ganglion cell apoptosis after optic nerve crush. EyeScience 2004;20:181-6.
- Steinsapir KD, Goldberg RA, Sinha S, Hovda D. Methylprednisoloneexacerbates axonal loss following optic nerve trauma in rats. RestorNeurolNeurosci 2000;17: 157-63.
- Fukado Y. Results in 400 cases of surgical decompression of the optic nerve. Mod ProblOphthalmol 1975;14:474-481
- Yu-Wai-Man P, Griffiths PG. Surgery for traumatic optic neuropathy. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD005024. DOI: 10.1002/14651858.CD005024.pub3
- Chou PI, Sadun AA, Chen YC, Su WY, Lin SZ, Lee CC. Clinical experiences in the management of traumatic optic neuropathy. Neuroophthalmology 1996;16 (6):325-336.
- Millesi W, Hollmann K, Funder J. Traumatic lesion of the optic nerve. Acta Neurochir (Wien) 1988;93(1-2):50 -54.
Corresponding Author
Dr Prabha Gupta
Senior Resident Dept of Ophthalmology,
Gajra Raja Medical College Gwalior, Madhya Pradesh, India
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