Clinical Profile and Visual Outcomes of Traumatic Optic Neuropathy

Abstract

Background: Indirect traumatic optic neuropathy (ITON) arises from concussive shockwaves, causing secondary optic nerve damage. Limited treatment options exist for traumatic optic neuropathy (TON), and the use of steroids remains contentious, addressing the absence of a standardized protocol for this ophthalmic emergency. Purpose: To evaluate the clinical presentation and visual prognosis of ITON as well as the efficacy of steroids in treating ITON. Methods: A retrospective analysis was conducted on patients diagnosed with ITON who sought medical attention spanning from January 2021 to December 2022. The study recorded the clinical profile as well as the ocular and cranial injuries. The study also evaluated the visual outcomes. Results: The total number of patients recruited in our study was 78. The mean age group found was 42 (ranging between 13 and 72 years of age). The most common mode of injury was a road traffic accident (83%), followed by home (10%) and factory accidents (7%). Only two cases had bilateral traumatic optic neuropathy. 93% of patients received steroids. The visual acuity at presentation was 6/6 to 6/18 in 32 cases (41%), 6/24 to 6/60 in 8 cases (10%), 5/60 to 3/60 in 1 case (1%) and worse than 3/60 in 37 cases (48%). Fifteen (20%) cases had optic canal fractures, and 15 (20%) had orbital wall fractures without optic nerve involvement. There was no noticeable improvement in visual acuity after 1 year. Only 9% improved, 3.9% worsened, and 87% remained unchanged. Conclusions: The study uncovered no significant association between visual acuity and treatment.

Keywords

• factory accident
• indirect traumatic optic neuropathy
• optic canal fracture
• road traffic accident
• trauma