Steroids for traumatic optic neuropathy

Trauma of the midface

“…20–60% of the patients experience an improvement of their vision [ 285 ], [ 286 ]. Since it was not possible to find an evidence for the effectiveness or superiority of the treatment with steroids or surgery compared to wait-and-see, the risks associated with therapy should be avoided [ 287 ].…”

“…Corticosteroids are applied since 40 years in traumatic lesions of the optic nerve [ 287 ]. The results of lesions of the central nervous systems in animal trials were transferred to the optic nerve in humans as the ON is part of the brain as well [ 288 ].…”

How Should Patients With Indirect Traumatic Optic Neuropathy Be Treated?

“…Despite 2 decades of ardent discussion, treatment attempts, clinical trial, and laboratory work, neuro-ophthalmologists have failed to develop a consensus opinion or to design an effective study to answer the question of whether any type of treatment benefits some patients with TON (1–3). This devastating optic neuropathy primarily affects young people in the prime of their life and involves 5 of 100,000 population, a prevalence similar to that of optic neuritis and nonarteritic ischemic optic neuropathy.…”

“…Numerous treatments have been suggested in the past, particularly surgical optic nerve decompression and high-dose systemic corticosteroids. However, more recent studies have suggested that no treatment might be better than potentially harmful therapeutic interventions, and the management of indirect TON remains highly controversial (1–3).…”

Analysis of the Peripapillary Retinal Nerve Fibre Layer Thickness Using Optical Coherence Tomography in Traumatic Optic Neuropathy

“…For diagnosis, computed tomography (CT) is the best imaging tool for delineating optic canal fractures, and magnetic resonance imaging (MRI) can be useful for evaluating the optic nerve, especially when assessing optic nerve avulsion, recent haemorrhage resulting in an optic nerve sheath haematoma, axonal injury, or ischaemia. 4,5 Optical coherence tomography (OCT) and scanning laser polarimetry (GDx) have been shown to facilitate the diagnosis and management of glaucoma by detecting the slow decrease in retinal nerve fibre layer (RNFL) thickness that occurs during the course of glaucomatous optic neuropathy. [6][7][8] Previous studies have also shown that changes in the optic disc and RNFL can be measured with OCT and GDx after acute injury to the optic nerve.…”