ABSTRACT
Traumatic optic neuropathy (TON) is characterized by impaired visual function due to acute damage to the optic nerve injury related to the trauma. The predictive incidence of TON in children and adolescence is 0.7-2.5% after blunt or penetrating head injuries. Orbital trauma is often accompanied by head injury and is the most common cause of unilateral vision loss. Here, we present a case of 11-year-old child who had the complaint of vision loss in the right eye and developed TON after a motor vehicle accident. The intubated patient was admitted to the pediatric intensive care unit after trauma and was operated due to epidural hemorrhage. Visual loss was detected during follow-up and orbital computed tomography revealed multiple fractures in the orbital walls and magnetic resonance imaging showed effusion of the optic nerve sheath and contrast enhancement of the optic nerve. Clinical and imaging findings suggested TON and as there was no indication for surgery, pulse steroid treatment was given for 5 days. With this treatment, the patient's vision loss and clinical findings improved significantly.
In conclusion, TON should be considered in patients with a head injury and post-traumatic vision loss. High-dose steroids should be considered in suitable patients.
Keywords:
Trauma, traumatic optic neuropathy, child
References
1Steinsapir K, Goldberg R. Traumatic Optic Neuropathy: A Critical Update. Medscape Web site. 2005;6:11-21.
2Ford RL, Lee V, Xing W, Bunce C. A 2-year prospective surveillance of pediatric traumatic optic neuropathy in the United Kingdom. J AAPOS. 2012;16:413-7.
3Stunkel L, Van Stavern GP. Steroid Treatment of Optic Neuropathies. Asia Pac J Ophthalmol (Phila). 2018;7:218-28.
4Anderson RL, Panje WR, Gross CE. Optic nerve blindness following blunt forehead trauma. Ophthalmology. 1982;89:445-55.
5Seiff SR. High dose corticosteroids for treatment of vision loss due to indirect injury to the optic nerve. Ophthalmic Surg. 1990;21:389-95.
6Kang KB, Jones S, Ahmad A, Moss HE. Optic Neuropathy with Delayed Onset After Trauma: Case Report and Review of the Literature. Neuroophthalmology. 2016;40:188-91.
7Levin LA, Beck RW, Joseph MP, Seiff S, Kraker R. The treatment of traumatic optic neuropathy: the International Optic Nerve Trauma Study. Ophthalmology. 1999;106:1268-77.
8Rajiniganth MG, Gupta AK, Gupta A, Bapuraj JR. Traumatic optic neuropathy: visual outcome following combined therapy protocol. Arch Otolaryngol Head Neck Surg. 2003;129:1203-6.
9Selvaraj VK, Viswanathan R, Devanathan V. Traumatic Optic Neuropathy - A Conundrum. J Clin Diagn Res. 2016;10:OD01-2.
10Steinsapir KD, Goldberg RA. Traumatic optic neuropathy. Surv Ophthalmol. 1994;38:487-518.
11Kaštelan S, Gverović Antunica A, Salopek Rabatić J, Gotovac M, Orešković D, et al. Traumatic Optic Neuropathy - Case Report with Discussion on Diagnostic Procedures and Therapy. Acta Clin Croat. 2018;57:166-72.