[Indirect traumatic optic neuropathy--problems and challenges in diagnosis and uncertainty in treatment]

Abstract

Traumatic optic neuropathy is one of the many facets of head injuries and a major cause of devastating permanent visual loss due to head injuries. Indirect traumatic optic neuropathy (ITON) occurs when blunt trauma to the forehead results in a transmission of force through the cranium to the confined portion of the optic nerve within the bony optic canal. The physics of the injuring forces that induced anatomical and histological effects on the optic nerve were thoroughly studied but the recognition of ITON in the acute stage still poses a diagnostic challenge. The accuracy of diagnosis still varies ten-fold among different centers. The use of Visual Evoked Potentials (VEP) in the evaluation of patients at risk of ITON will improve the diagnostic abilities. The clinical course varies between immediate and permanent visual loss of varied severity, delayed deterioration and spontaneous recovery. No clinical technique, however, proved to provide predictive abilities. None of the current forms of treatment--conservative, high dose steroids and surgical decompression of optic nerve, were found to be superior, and the patient series are still too small. The reviewers recommend establishing a national registry of ITON that will facilitate the improvement of the diagnosis and will contribute to the adoption of an evidence-based therapeutic approach.