Traumatic optic neuropathy in children and adolescents

Goldenberg-Cohen, Nitza; Miller, Neil R.; Repka, Michael X.

doi:10.1016/j.jaapos.2003.08.009

Cited by 60 publications

(48 citation statements)

References 23 publications

(38 reference statements)

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“…25,26 Previous epidemiological data derived from multiple retrospective case series and the IONTS have indicated male preponderance, young age, and leading causes from RTAs, falls, and assaults in both adult 27 and paediatric 28,29 cohorts. Despite our study utilizing an effective active surveillance methodology that received high levels of support from the UK ophthalmologists, 30,31 there remained a certain level of underascertainment and consequently we are reporting minimum estimates of incidence rates.…”

Section: Epidemiologymentioning

confidence: 99%

Surveillance of traumatic optic neuropathy in the UK

Lee

Ford

Xing

et al. 2009

Eye

114

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Aims The aim of this study is to provide epidemiological data on the incidence, aetiology, management, and visual outcome in traumatic optic neuropathy (TON) in the UK. Methods Patients with TON were identified prospectively by population-based active surveillance through the British Ophthalmic Surveillance Unit over a 2-year period with data obtained from an incident questionnaire and follow-up questionnaire sent to positive reporters. Results Incident and follow-up data were available on 121 and 97 (80%) patients, respectively. The minimum estimated incidence was 1.005 per million. Leading causes included falls (25.6%), road traffic accidents (RTAs) (21.5%), and assaults (20.7%). The median age was 31 years. There were 95 (78.5%) men. Presenting visual acuity (VA) was 6/60 or worse in 85 (70%) patients, with 43 patients (36%) with no perception of light. Associated injuries included 47 (39%) orbital wall fractures, 37 (31%) closed globe injuries, 23 (19%) ocular adnexal injuries, 23 (19%) skull fractures, and 18 (16%) intracranial bleeding. Sixty-five percent (75/116) received no acute treatment and 35% (41/116) received steroids and/or surgery. Of the treated group, 24% (8/ 33) and of the untreated group 20% (11/56) improved three lines or more of VA (P ¼ 0.61). Prompt ophthalmic examination (P ¼ 0.002), orbital fracture (P ¼ 0.046), high Glasgow Coma Scale (GCS) score (P ¼ 0.023), and poor initial VA (P ¼ 0.009) were associated with increased likelihood of treatment. Poor initial VA (Po0.001), orbital fracture (P ¼ 0.004), and significant head injury (P ¼ 0.038) were associated with poor visual outcome. Conclusions This study suggested that young men were at greatest risk of TON. We detected a trend towards conservative management of this condition in the UK. TON was associated with significant ocular, orbital, and head injuries that highlighted the need for multidisciplinary management.

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Section: Epidemiologymentioning

confidence: 99%

Surveillance of traumatic optic neuropathy in the UK

Lee

Ford

Xing

et al. 2009

Eye

114

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“…The management protocol is better defined in the adult population but its applicability to the pediatric population is not well defined. There are only a few studies in the English literature which have dealt with pediatric traumatic optic neuropathy [2,3]. We here report our experience of combined …”

Section: Introductionmentioning

confidence: 96%

Traumatic optic neuropathy in pediatric population: Early intervention or delayed intervention?

Gupta

et al. 2007

International Journal of Pediatric Otorhinolaryngology

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“…56 Traumatic optic neuropathy occurs in 0.5%-12% of TBI patients 24,97 with approximately 20% of pediatric cases due to sports-related injuries. 42,46 The clinical presentation of traumatic optic neuropathy can vary from subtle monocular blurred vision or visual field deficits to complete blindness. All patients with suspected cranial nerve injuries affecting vision should be promptly referred to a neuro-ophthalmologist for comprehensive assessment.…”

Section: Discussionmentioning

confidence: 99%

“…Most patients with traumatic optic, oculomotor, trochlear, and abducens neuropathies that present with mild deficits improve with conservative management, while those with complete injuries rarely experience a complete recovery. 42,46,63,88 Despite a relatively good prognosis, there are no evidence-based guidelines to help direct RTP and retirement decision making in these populations. Nevertheless, because of the potential risk of recurrent injury and the significant disability associated with permanent injury, it has been our institutional approach to recommend retirement from contact and collision sports in all pediatric SRC patients presenting with traumatic cranial nerve palsies even after clinical recovery has been achieved.…”

Section: Discussionmentioning

confidence: 99%

Retirement-from-sport considerations following pediatric sports-related concussion: case illustrations and institutional approach

Ellis

McDonald

Cordingley

et al. 2016

FOC

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Neurosurg Focus 40 (4):E8, 2016S portS-related concussion is a form of traumatic brain injury (TBI) that affects millions of North Americans annually. 27,60,73 Historically, SRC has been viewed as a functional disturbance of cerebral metabolism and blood flow that results in temporary alterations in neurological functioning that resolve within 7-10 days. 68,69 More recently, however, increasing attention has focused on the more serious effects of concussion and subconcussive injuries including abnormalities documented on advanced structural neuroimaging studies and the longterm risk of developing cognitive impairment, mood disorders, and neurodegenerative diseases including chronic traumatic encephalopathy (CTE). 7,29,44,48,49,51,65,70,71,80,94,98,99 To mitigate the risks of more serious brain injury following SRC, experts offer consensus statements containing supervised return-to-play (RTP) guidelines that promote the safe return of athletes to the field of play after concussion symptoms have fully resolved. 4,68,69 These guidelines may reduce the risk of second-impact syndrome, a very rare and poorly defined condition thought to arise from loss of cerebral autoregulation and resultant diffuse cerebral edema. 67 However, they do not provide direction as to whether athletes should be advised to avoid future contact and collision sports because of the risk of adverse short-and long-term outcomes associated with future concussion. Over the years, several authors have offered recommendations about when athletes should be advised to retire from contact or collision sports, but most have focused on collegiate and professional athletes. 16,18,20,21,23,43,66,76,91,93 Although some authors suggest a more conservative approach should be applied to child and adolescent athletes, 16,23 indications for retirement from sports remain controversial and there are limited reports that discuss these issues in application to pediatric SRC patients. Because decisions regarding athlete retirement are complex and must be tailored to the individuals in the absence AbbreviAtioNs CTE = chronic traumatic encephalopathy; PCS = postconcussion syndrome; RTP = return to play; SCI = spinal cord injury; SCIWORA = SCI without radiographic abnormality; SRC = sports-related concussion; TBI = traumatic brain injury. The decision to advise an athlete to retire from sports following sports-related concussion (SRC) remains a persistent challenge for physicians. In the absence of strong empirical evidence to support recommendations, clinical decision making must be individualized and should involve a multidisciplinary team of experts in concussion and traumatic brain injury. Although previous authors have advocated for a more conservative approach to these issues in child and adolescent athletes, there are few reports outlining considerations for this process among this unique population. Here, the authors use multiple case illustrations to discuss 3 subgroups of clinical considerations for sports retirement among pediatric SRC patients including the ...

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Traumatic optic neuropathy in children and adolescents

Cited by 60 publications

References 23 publications

Surveillance of traumatic optic neuropathy in the UK

Surveillance of traumatic optic neuropathy in the UK

Traumatic optic neuropathy in pediatric population: Early intervention or delayed intervention?

Retirement-from-sport considerations following pediatric sports-related concussion: case illustrations and institutional approach

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