Traumatic Optic Neuropathy

  • An-Guor Wang


A 44-year-old 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. He received intravenous pulse steroid therapy for 3 days under the impression of traumatic optic neuropathy OD. His vision did not improve much after therapy. He came to our clinic for a second opinion. His best-corrected visual acuity was hand motion at 15 cm OD and 6/6 OS. Intraocular pressures and anterior segments were normal on exam. There was a relative afferent pupillary defect (RAPD) in the right eye. Ophthalmoscopic examination showed mild optic disc pallor in the right eye (Fig. 6.1). OCT showed mild thinning of the peripapillary retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) in the right eye when compared to the left eye (Fig. 6.2). One month later, his vision remained stable, but both the peripapillary RNFL and macular GC-IPL were shown to be moderately impaired (Fig. 6.3).


  1. 1.
    Yu-Wai-Man P. Traumatic optic neuropathy-clinical features and management issues. Taiwan J Ophthalmol. 2015;5(1):3–8.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Singman EL, Daphalapurkar N, White H, Nguyen TD, Panghat L, Chang J, McCulley T. Indirect traumatic optic neuropathy. Mil Med Res. 2016;3:2.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Anderson RL, Panje WR, Gross CE. Optic-nerve blindness following blunt forehead trauma. Ophthalmology. 1982;89:445–55.CrossRefPubMedGoogle Scholar
  4. 4.
    Gross CE, Dekock JR, Panje WR, Hershkowitz N, Newman J. Evidence for orbital deformation that may contribute to monocular blindness following minor frontal head trauma. J Neurosurg. 1981;55:963–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Pirouzmand F. Epidemiological trends of traumatic optic nerve injuries in the largest Canadian adult trauma center. J Craniofac Surg. 2012;23:516–20.CrossRefPubMedGoogle Scholar
  6. 6.
    Shi W, Wang HZ, Song WX, Yang WL, Li WY, Wang NL. Axonal loss and blood flow disturbances in the natural course of indirect traumatic optic neuropathy. Chin Med J. 2013;126:1292–7.PubMedGoogle Scholar
  7. 7.
    Tsai HH, Jeng SF, Lin TS, Kueh NS, Hsieh CH. Predictive value of computed tomography in visual outcome in indirect traumatic optic neuropathy complicated with periorbital facial bone fracture. Clin Neurol Neurosurg. 2005;107:200–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Yu-Wai-Man P, Griffiths PG. Surgery for traumatic optic neuropathy. Cochrane Database Syst Rev. 2005;4:CD005024.Google Scholar
  9. 9.
    Yu-Wai-Man P, Griffiths PG. Steroids for traumatic optic neuropathy. Cochrane Database Syst Rev. 2011;1:CD006032.Google Scholar
  10. 10.
    Volpe NJ, Levin LA. How should patients with indirect traumatic optic neuropathy be treated? J Neuroophthalmol. 2011;31:169–74.CrossRefPubMedGoogle Scholar
  11. 11.
    Levin LA, Baker RS. Management of traumatic optic neuropathy. J Neuroophthalmol. 2003;23:72–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Xie D, Yu H, Ju J, Zhang L. The outcome of endoscopic optic nerve decompression for bilateral traumatic optic neuropathy. J Craniofac Surg. 2017;28(4):1024–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Edwards P, Arango M, Balica L, et al. Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury — outcomes at 6 months. Lancet. 2005;365:1957–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Roberts I, Yates D, Sandercock P, Farrell B, Wasserberg J, Lomas G. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo- controlled trial. Lancet. 2004;364:1321–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Alderson P, Roberts I. Corticosteroids for acute traumatic brain injury. Cochrane Database Syst Rev (Online). 2005;(1):CD000196.Google Scholar
  16. 16.
    Levin 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.CrossRefPubMedGoogle Scholar
  17. 17.
    Carta A, Ferrigno L, Salvo M, Bianchi-Marzoli S, Boschi A, Carta F. Visual prognosis after indirect traumatic optic neuropathy. J Neurol Neurosurg Psychiatry. 2003;74(2):246–8.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • An-Guor Wang
    • 1
  1. 1.Department of OphthalmologyTaipei Veterans General Hospital, National Yang-Ming University School of Medicine, Yun-San Ophthalmology Education Research FoundationTaipeiTaiwan

Personalised recommendations