Traumatic optic neuropathy: Clinical approach

Traumatic optic neuropathy can be associated with even very mild head trauma. The severity of initial vision impairment varies from amaurosis to 616, with associated episodes of visual field defects. Apart from war situations, traffic accidents are the most common cause, however, iatrogenic injuries and sports lesions should by no means be neglected. The classification into direct and indirect injuries has some limitations, so that the diffusion according to anatomical involvement may occasionally appear to be more appropriate. The clinical picture is predominated by impairments of the visual acuity, field of vision, color vision, and relative afferent pupillary defect in unilateral or bilateral but asymmetric involvement. Computed tomography is highly useful in the acute diagnostic procedure for traumatic optic neuropathy. Concerning the management of traumatic optic neuropathy, reports on medicamentous therapy with steroids prevail, however, the dosage remains a matter of dispute, whereas data from properly controlled prospective studies are lacking in relation to operative therapy for traumatic optic neuropathy.