Clinical profile and visual outcomes of traumatic optic neuropathy

Abstract

Background: Road traffic accidents (RTA) are the leading cause of disabilities among people aged 15-30 years. Traumatic optic neuropathy (TON) occurs in upto 5% of closed head traumas. It is an ophthalmic emergency for which there is no standardized treatment protocol. Purpose: To evaluate clinical presentations and visual outcome of TON. Methods: Retrospective analysis of 56 TON patients treated in a tertiary eye care facility over three years. Clinical profile, ocular and cranial injuries were recorded. Visual outcomes of treated (1gm/day intravenous methylprednisolone for three days followed by oral prednisolone 1 mg/kg over 2 weeks) and untreated patients were analysed.Best corrected visual acuity at one month follow up was taken as the primary outcome measure. Statistical analysis was done using Mann-Whitney U test and Wilcoxon sign rank test. Results: Of 56, nine patients had presenting vision >6/60 and 47 had ≤6/60. Forty four out of 56 patients received intravenous and oral steroids, of them, >2 line improvement was seen in 25 patients. Final vision of >6/60 was recorded in 32 patients (31 treated,1untreated). 24 patients had a final vision ≤6/60 (13 treated, 11 untreated). Significant difference between baseline visual acuity and post treatment visual acuity at one month review was noted in patients who received steroids (P = 0.001). Of the 12 Patients managed conservatively no significant improvement was seen. Conclusion: Patients with baseline vision >= 6/60 improved after high dose IV methylprednisolone but those with very poor baseline vision on and those managed conservatively did not significant improvement. No major side effects were encountered with the above stated steroid regimen.

Keywords

• extra ocular muscle palsy
• methylprednisolone
• road traffic accidents
• traumatic optic neuropathy