Abstract
A host of different types of direct and indirect, primary and secondary injuries can
affect different portions of the optic nerve(s). Thus, in the setting of penetrating
as well as nonpenetrating head or facial trauma, a high index of suspicion should
be maintained for the possibility of the presence of traumatic optic neuropathy (TON).
TON is a clinical diagnosis, with imaging frequently adding clarification to the full
nature/extent of the lesion(s) in question. Each pattern of injury carries its own
unique prognosis and theoretical best treatment; however, the optimum management of
patients with TON remains unclear. Indeed, further research is desperately needed
to better understand TON. Observation, steroids, surgical measures, or a combination
of these are current cornerstones of management, but statistically significant evidence
supporting any particular approach for TON is absent in the literature. Nevertheless,
it is likely that novel management strategies will emerge as more is understood about
the converging pathways of various secondary and tertiary mechanisms of cell injury
and death at play in TON. In the meantime, given our current deficiencies in knowledge
regarding how to best manage TON, “primum non nocere” (first do no harm) is of utmost
importance.
Keywords
optic neuropathy - trauma - traumatic optic neuropathy - steroids - optic canal decompression
