Secondary Traumatic Optic Neuropathy Following Facial Bone Fracture: A Case Report

Abstract

 Secondary traumatic optic neuropathy is difficult to treat because there are no clear guidelines for treatment, and it is therapeutically challenging. We report a case of secondary visual impairment that persisted despite treatment for trauma-induced optic neuropathy. A 42-year-old man presented to our hospital following facial trauma sustained in a traffic accident. Computed tomography of the facial bones revealed significant displacement of the ethmoid bone to the left, with compression of the left orbital tissue including the optic nerve. Although the patient suffered an intracranial injury, he exhibited no apparent visual impairment. Therefore, it was decided that he was ineligible for emergency surgery. Unexpectedly, on the second day of hospitalization, the patient developed left visual impairment and was diagnosed with traumatic optic neuropathy. After undergoing facial bone fracture reduction surgery and orbital tissue compression, he was released postoperatively. Steroids were also initiated as adjunctive therapy; however, he did not recover vision in his left eye.
 Our findings suggest that appropriate selection of timing and treatment method for traumatic optic neuropathy in patients with other trauma-induced injuries is important.