1994 Volume 87 Issue 10 Pages 1369-1377
Disagreement remains concerning the proper treatment of patients with indirect optic nerve injury.
This report summarizes the diagnosis and treatment of 13 patients who were examined with high-resolution computed tomography and reviews the literature on this rare injury.
Several pathogenic mechanisms, including edema, compression and ischemia of the optic nerve, seem to be involved, although the natural history of traumatic optic neuropathy is not clear.
The time from injury to treatment, the level of consciousness at the time of injury and the presence of optic canal fracture do not correlate well with the recovery or nonrecovery of vision.
The improvement of visual acuity was not always better in patients treated surgically than in those treated conservatively. Immediate operation after the injury did not assure a good prognosis.
Our observations suggest that the first choice of treatment for optic nerve injury is the administration of a high dose of a steroid, unless visual acuity grows worse. If vision fails to improve within a week, one should consider decompression by an intracranial or transethmoidal approach depending on the site of the fracture.
