Clinical experiences in the management of traumatic optic neuropathy

This study describes 58 cases of sudden visual loss following blunt head injury seen from October 1986 to February 1992 at the Tri-Service General Hospital, Taiwan. Twenty-three patients (the medical group) were treated with intravenous dexamethasone or oral prednisolone; 25 patients (the surgical group) underwent optic canal decompression in addition to medical treatment. Ten cases were carefully monitored without any kind of treatment; these patients served as controls. None of the control patients showed any improvement in visual acuity. Thirteen of the 23 cases (57%) in the medical group had visual improvement (P=0.002), while 15 of 25 cases (60%) in the surgical group had visual improvement (P=0.0002). Patients with vision better than light perception immediately after the trauma benefitted more from treatment than did the patients with complete visual loss (73% vs 25% improved in the medical group; 80% vs 55% improved in the surgical group). Twelve of the 58 cases (21%) had a fracture of the medial wall of the optic canal, as seen by computed tomographic scan. Such optic canal fracture was correlated with poor visual acuity and poor prognosis. Of these It cases, eight presented with complete visual loss, while the other four presented with less than counting fingers; the best corrected vision after treatment in these patients remained less than 20/200.