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Santosh University Journal of Health Sciences


Traumatic optic neuropathy after head injury


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Author Details: Anshu Sharma, Awantika Bhadauria, Sarita Aggarwal, Himanshu Sardana, Richa Yadav

Volume : 2

Issue : 2

Online ISSN : 2455-1732

Print ISSN :

Article First Page : 101

Article End Page : 105


Abstract

Purpose: To study the clinical profile, prognostic factors and the effect of systemic steroids in the management of traumatic optic neuropathy.
Materials and Method: A minimum of forty four patients with closed head injury with complaints of any of the following: decreased visual acquity following trauma, RAPD, defective colour vision, visual field defects or CT scan showing fracture of any orbital wall were selected randomly and detailed ocular examination was done. Patients were treated with IVMP.
Results: Patient age ranged from 11-69 years. The causes of head injury were road traffic accidents (86.4%), accidental falls (9.1%), and assault (4.5%). Majority of patients were male (93.18%). Unilateral involvement was seen in 95.45% cases. 61.36% cases were drowsy, 36.36% cases conscious and 2.27% cases were unconscious after the injury. In this study 34.78% of patients had profound loss of vision PL+ or HM (hand movements) as the initial vision. 13.04% cases had a visual acquity 6/18 or better. In 43.47% cases extraocular movements were restricted. RAPD was present in 95.5% of eyes. 82.60% of patients presented with sub conjunctival hemorrhage. CT scan coronal view showed optic nerve sheath thickening in 17.39% patients. The most common fractures noted were fracture floor of orbit in 23.19% cases and medial wall of orbit in 15.21% cases. 38 patients were treated with intravenous Methyl prednisolone within 24 -72 hrs. of suspicion of traumatic optic neuropathy. Initial ophthalmoscopic examination was conducted on 46 eyes and optic disc was normal in all cases except one who showed mild disc edema. In 6 to 12 weeks more than 50% optic discs became pale. Optic disc pallor developed in about 81.5 % cases in 6 months. In the present study out of six; 5 patients showed spontaneous improvement without treatment, but treated patients appeared to have a better visual acuity and visual fields.
Conclusion: Road traffic accidents were the most common cause associated with TON and males being more commonly involved. Treated patients had a better visual prognosis. On follow up, it was noted that visual acuity improved in patients who had initial vision more than light perception and in patients with no optic canal fractures.

Keywords:
Head injury, Optic canal fracture, Optic nerve, Steroids, Traumatic optic neuropathy