Traumatic optic neuropathy is a cause of loss of vision associated with head injuries. Treatment options include observation, steroids and decompression of the optic canal. We report a case where the optic canal decompression was performed using a transcaruncular approach under a regional block. The incision was made through the caruncle and the dissection was carried down to the periosteum down to the orbital apex where the optic nerve was seen exiting through the optic canal posterior to the posterior ethmoidal artery. The optic nerve was decompressed with good visualization. Hemostasis and wound closure was achieved using fibrin glue. Postoperatively visual acuity improved with minimal inflammation enabling early rehabilitation.
Central retinal artery occlusion is a rare association of traumatic optic neuropathy. Superselective fibrinolytic therapy is a management option for central artery occlusion that reduces systemic side effects of thrombolysis. A rare case of posttraumatic central retinal artery occlusion is described where optic nerve decompression was performed followed by restoration of central retinal flow by direct puncture of ophthalmic artery and institution of fibrinolytic therapy.
Traumatic optic neuropathy is a cause of sudden irreversible visual loss due to optic nerve damage following trauma. Reports of improvement have been noted after observation alone, treatment with corticosteroids, and surgical decompression. However, final visual acuity may not be predictable, with individual patients having little improvement in visual function despite therapy. Perceptual learning improves visual functions by improving the neural processing so as to allow image perception at low signal-to-noise ratios. The case report describes the beneficial effect of perceptual learning in traumatic optic neuropathy, the first to describe the use of perceptual learning in an optic neuropathy. A larger case-controlled study of the effect of perceptual learning in optic neuropathies is required to substantiate the beneficial effect and elaborate the scale of improvement that may be possible with this form of therapy.
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