Traumatic Optic Neuropathy in Children: A Prospective Study

Abstract

Fifty children with indirect optic nerve injury were prospectively studied over an 8-year period. They constituted 20% of all patients with optic nerve injury managed on a slightly different protocol. Half of these children were injured due to fall from a height, followed by road traffic accidents in 40% of the cases. Forty-three children had unilateral and 7 children had bilateral visual impairment. Five children had definite history of delayed-onset visual involvement, which ranged from 12 to 72 h following injury. Fifty percent of these children had fractured skulls and 14% had optic canal fracture. Visual evoked potentials were performed in 43 patients of which wave formation was normal in 7 and abnormal in 14 patients. The remaining 22 patients had no wave formation. All the patients were managed conservatively and received corticosteroids for a period of 3 weeks. In 7 children an optic nerve decompression was performed between 4 and 6 weeks following injury. Spontaneous visual improvement was observed in 20 (40%) children. In all the patients onset of visual recovery was noticed within 3 weeks. Of the 7 children who had optic nerve decompression, 4 had minimal spontaneous recovery and their vision remained static. All these 4 children benefited by surgery and the vision improved further following the decompression. Three children had no perception of light prior to surgery and none of these patients showed visual improvement following surgery. The present study brings out the clinical profile of children with optic nerve injury and the indications of surgery in these patients.

Surveillance of traumatic optic neuropathy in the UK

“…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.…”

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

“…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 …”

High-dose intravenous methylprednisolone in recent traumatic optic neuropathy; a randomized double-masked placebo-controlled clinical trial

“…Various options include highdose [12] or low-dose [18] corticosteroids, immediate decompression of the canalicular portion of the optic nerve [17], decompression of the canalicular optic nerve after a course of systemic corticosteroids [8,15], observation and optic-nerve sheath fenestration in cases of anterior TON [7]. In a comparative nonrandomized interventional study, Levin et al [5] found no clear benefit for either corticosteroid therapy, optic canal decompression, or observation in the treatment of TON.…”