Pdf traumatic optic neuropathy ton is an important cause of severe visual loss after blunt or penetrating head and facial trauma. Traumatic optic neuropathy often results in severe visual loss and the vast majority of affected patients are young males in their thirties. Outcome of endoscopic transethmosphenoid optic canal. The optic nerve axons may be damaged either directly or indirectly and the visual loss may be partial or complete. Direct traumatic optic neuropathy ton is a devastating condition and clinical challenge. Abstractwe present a case as a rare sign of traumatic optic neuropathy and central retinal. Posterior lesions, on the other hand, are often free of ophthalmoscopic findings, but disc edema acutely and optic nerve pallor eventually do occur. Indirect traumatic optic neuropathy iton vision center of. Traumatic optic neuropathy ton is a rare devastating complication of traumatic head injury and is an ophthalmic emergency.
Traumatic optic neuropathy ton refers to an acute injury of the optic nerve secondary to trauma. Traumatic optic neuropathy ton is an important cause of severe visual loss following blunt for penetrating head and facial trauma. Traumatic optic neuropathy ton is a paradox of superficial simplicity riddled with deep and hidden complexities. Abstractwe present a case of acute traumatic optic neuropathy in 54 year old male patient. Visual acuity of the right eye following traumatic optic neuropathy. Traumatic optic neuropathy ton is a condition in which acute injury to the optic nerve from direct or indirect trauma results in vision loss. Traumatic optic neuropathy ton is commonly associated with head trauma, and thus is a known comorbidity of traumatic brain injury tbi.
Traumatic optic neuropathy can be treated by various methods including steroids and surgical decompression. Traumatic optic neuropathyassociated progressive thinning of. First and foremost, we recommend establishing whether the injury falls into one or more of the. Magnetic resonance imaging revealed right optic nerve atrophy. A entry site of a projectile in the medial canthal region of the right eye. Traumatic optic neuropathy treatment trial tontt full. Traumatic optic neuropathy ton refers to any insult to the optic nerve secondary to trauma. The optic nerve is vulnerable to indirect and direct trauma causing functional impairment of vision. Indirect traumatic optic neuropathy connecting repositories. He had noted decreased visual acuity on the left side. Traumatic optic neuropathy prediction after blunt facial.
Models and treatments for traumatic optic neuropathy and. Ton can be caused by sharp trauma damaging the optic nerve directly, which usually results from optic nerve avulsion or laceration, or from direct fracture of the optic canal with bony fragments injuring or transecting the optic nerve. Traumatic optic neuropathy occurs when the optic nerve transitions from being normal and functional to having a paleatrophic appearance. Clinical treatment of traumatic optic neuropathy in. Traumatic optic neuropathy optic nerve decompression. The natural history of traumatic optic neuropathy has not been studied.
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. Pdf we present a case of acute traumatic optic neuropathy in 54 year old male. This can occur weeks to months after a directindirect traumatic event. Clinical treatment of traumatic optic neuropathy in children. The causes of ton are thought to be multifactorial. Traumatic optic neuropathy ton may result from either direct or indirect injury.
Indirect damage to the optic nerve is the most common form of traumatic optic neuropathy, occurring in 0. 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. 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. 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.
A case series that included two groups of iton patients. Outline introduction epidemiology pathophysiology work up management prognosis 19. Ton can be classified into transection and compressive forms of neuropathy. Direct ton is diagnosed when projectiles, knives, or other objects penetrate the orbit and result in optic nerve damage by direct contact 1, 2.
This process is thought to be multifactorial and can result in highly variable visual outcomes for the patient. Traumatic brain injury is one of the leading causes of disability and mortality in the united states. 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. Indirect traumatic optic neuropathy iton eye exam source dvids. Traumatic optic neuropathy ton is a rare cause of severe permanent visual impairment following injury. The reported incidence of traumatic optic neuropathy ton ranges from 1. Eric singman, et al wilmer eye institute at johns hopkins hospital, baltimore, maryland. Traumatic optic neuropathyassociated progressive thinning. Surgery has been used in ton to try and reduce this abnormal swelling or remove bone fragments. A host of different types of direct and indirect and primary and secondary injuries can affect different portions of the optic nerves. 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.
The full text article is available at the following link. Original treatment options included observation or optic canal decompression through a frontal craniotomy. Why do we need optic nerve decompression of traumatic. Cureus craniotomy improves traumatic optic neuropathy. Visual outcome of traumatic optic neuropathy in patients.
Traumatic optic neuropathy ton is an acute injury of the optic nerve secondary to trauma. Visualevokedresponsesupported outcome of intravitreal. 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. Karthikeyan 1 free download as powerpoint presentation. Ct scan of an 18yearold involved in a severe motor vehicle accident. Ton, though uncommon, causes substantial visual loss. Ton can be caused by sharp trauma direct injury damaging the optic nerve directly, but. The mechanism of injury is not understood, and there are no confirmed protocols for prevention, mitigation or treatment. Surveillance of traumatic optic neuropathy in the uk eye. The ct scan shows fracture in the area of the left optic canal, with a bone fragment arrow impinging on the left optic nerve. Aug 21, 2015 epidemiology traumatic optic neuropathy occurs in 0.
Why do we need optic nerve decompression of traumatic optic. Examinations revealed the visual acuity was 660 with a marked. The aim of this study was to assess the outcome of treating traumatic optic neuropathy with steroids and endoscopic surgical decompression. This impact may create a shock wave which can lead to optic nerve avulsion or posterior indirect traumatic optic neuropathy.
Kersten md, facs introduction approach to traumatic visual loss patients can undergo visual loss after a traumatic insult to the eye or periorbital structures. To evaluate the safety and outcomes of endoscopic transethmosphenoid optic canal decompression etocd for children with indirect traumatic optic neuropathy iton. Connecting endoplasmic reticulum and oxidative stress to. Endoscopic optic nerve decompression has been suggested to be effective in treating this condition. 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. An evidencebased perspective on management harmeet s.
All of this data is consistent with the patients diagnosis of traumatic optic neuropathy, but his visual recovery in the affected eye was remarkable. Ton has not received much attention in basic research despite being associated with permanent vision loss, color blindness, and loss of visual fields. Needless to say, it has formed the topic of much debate in the past, especially with regard to its surgical management. Traumatic optic nerve damage after craniofacial injury was first described by hippocrates. 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. This article is from journal of clinical medicine research, volume 3.
Investigating the efficacy of intravitreal injection of erythropoietin epo in managing indirect traumatic optic neuropathy iton of different durations. To present a case of unilateral indirect traumatic optic neuropathy ton and stress the importance of early megadose steroid treatment. Traumatic optic neuropathy ton is an important cause of severe visual loss after blunt or penetrating head and facial trauma. Examinations revealed the visual acuity was 660 with. Traumatic optic neuropathy ton is based on a clinical diagnosis of optic nerve dysfunction supported by a recent history of trauma to the head. Indirect traumatic optic neuropathy iton refers to optic nerve injury resulting from impact remote to the optic nerve. Indirect ton occurs because of irreversible contusion necrosis from shearing of retinal ganglion cell axons in patients with nonpenetrating trauma 1. Epidemiology traumatic optic neuropathy occurs in 0. Traumatic optic neuropathy is a condition characterized by visual. Traumatic optic neuropathy ton is common in patients with head injuries. Highdose steroids and surgical interventions have been applied in. Hyperbaric oxygen hbo2 therapy has been proposed as an adjunctive treatment for eye disease but has rarely been used in optic neuropathy. Treatment of ton is divided primarily into two categories.
The management of traumatic optic neuropathy remains controversial. Traumatic optic neuropathyclinical features and management. Most data concerning this condition comes from case series of civilian patients suffering blunt injury, such as from sports or motor vehiclerelated. Traumatic optic neuropathy is visual loss caused by trauma to the optic nerve. In this report, we present the results of 45 patients treated with extracranial optic nerve decompression after at least 12 to 24.
Visual acuity improved after transethmoidal decompression of the canal. The severity of optic nerve damage may range from simple contusion to complete avulsion of the optic nerve. Traumatic optic neuropathy ton is the affectation of the visual function, secondary to a damage caused by a direct or indirect traumatic mechanism over the optic nerve. To prevent a poor outcome, aggressive management is required. Injuries, classified as direct or indirect, are also characterized by location. A 44yearold male sustained a fall with right brow injury about 3 weeks prior to admission to a local hospital for visual loss in the right eye. Traumatic optic neuropathy ton is classified into direct and indirect injuries. Traumatic optic neuropathy ton is an uncommon but devastating cause of permanent visual loss following blunt force trauma to the orbit. Sep, 2018 traumatic optic neuropathy ton is based on a clinical diagnosis of optic nerve dysfunction supported by a recent history of trauma to the head.
In an acute setting following trauma, the diagnosis may be delayed if the patient is unconscious and a formal visual acuity assessment cannot be performed. Ton has not received much attention in basic research despite being associated with permanent vision loss. Benefit of hyperbaric oxygen therapy treatment in direct. Surgery for the treatment of traumatic optic neuropathy. Clinical features and treatments for traumatic optic neuropathy ton. Introduction whenever there is a head trauma the optic nerves are by far the most common site of visual pathway trauma. The types of ton are direct, anterior indirect, posterior indirect, and. 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. Pdf diagnosis of traumatic optic neuropathy stuart.
Traumatic optic neuropathy and second optic nerve injuries. Traumatic optic neuropathy our experience springerlink. Indirect traumatic optic neuropathy military medical. One large study found that 85% of patients were male, with a mean age of 34 years. Herein, we report a rare case of a 46yearold gentleman who experienced severe blurring of vision, binocular diplopia, and pain over his left eye following a fall from a tree about three meters in height.
Visual prognosis after indirect traumatic optic neuropathy. In this report, we present the results of 45 patients treated with extracranial optic nerve decompression after at. 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. Pdf surgical treatment for traumatic optic neuropathy. A novel mouse model of traumatic optic neuropathy using. After the optic nerve has been injured, it becomes more swollen and this can lead to further damage. Updating traumatic optic neuropathy academic journals. Traumatic optic neuropathy ton is an acute injury of the optic. Most data concerning this condition comes from case series of civilian patients suffering blunt injury, such as from sports. Main outcome measure was improvement in visual acuity after treatment.
Pdf traumatic optic neuropathy to treat or to observe. Sep, 2018 traumatic optic neuropathy ton refers to an acute injury of the optic nerve secondary to trauma. Dramatic visual recovery in untreated indirect traumatic. A great deal of controversy surrounds the physiology and management of traumatic optic neuropathy. 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 nove.