Traumatic optic neuropathy in children and adolescents

Purpose: Retrospective review to describe the features and visual outcome of traumatic optic neuropathy (TON) in children and adolescents. Methods: Interventional and observational case series of children <18 years with TON. Results: Forty children, 24 boys and 16 girls, were identified with 43 affected eyes. The mean age was 11.6 years (range, 2 to 18). The most common causes were motor vehicle accidents (62%) and sports injuries (22%). The trauma was blunt in 78% of cases and penetrating in 22%. Visual acuity at presentation for 27 patients whose visual acuity could be assessed ranged from no light perception to 20/80. Interventions included corticosteroids (n = 18), decompression of the optic canal (n = 3), and optic sheath nerve fenestration (n = 1). Visual outcome for 22 children with at least 1 month of follow-up was no light perception in 10 (45%), < 20/200 in 7(32%), 20/200 to < 20/80 in 1(4%), and greater than or equal to 20/80 in 4 (18%). There was no difference in the rate or degree of improvement between treated and untreated patients. Conclusion. TON in children is caused by mechanisms similar to those that cause TON in adults. The severity of visual loss as well as the rate and degree of improvement are also similar. Our data do not indicate that treatment improves visual outcome.