Traumatic Optic Neuropathy

Abstract

Purpose: To present a case of unilateral indirect traumatic optic neuropathy (TON) and stress the importance of early megadose steroid treatment.

Material and Methods: A 15 years old boy presented with loss of vision left eye following a road traffic accident 4 weeks back. On examination of the left eye his visual acuity was no perception of light and relative afferent papillary defect (RAPD) was positive. Anterior and posterior segment examination was normal. There were no retinal hemorrhages. The patient was diagnosed as a case of left indirect TON. All investigations were within normal limits except VEP, which showed an abnormal response in the left eye.

Results: On examination at 6 weeks post-trauma there was 15-200 exotropia left eye with poor recovery. Visual acuity in the left eye remained NPL and RAPD was positivite. On fundoscopy the optic disk was yellow white in color with normal appearing retinal vessels.

Conclusion: TON is a neuro-ophthalmic emergency and early intervention is crucial. Intravenous megadose methylprednisolone (MP) within 8 hours of TON can save useful vision in some cases.