Traumatic Optic Neuropathy Prediction after Blunt Facial Trauma: Derivation of a Risk Score Based on Facial CT Findings at Admission

Abstract

The risk model developed may help radiologists suggest the possibility of TON and prioritize ophthalmology consults. However, future external validation of this prediction model is necessary.

Incidence of optic canal fracture in the traumatic optic neuropathy and its effect on the visual outcome

“…The role of CT in orbital trauma has been well established, and OCF has been reported to be optimally visualised with thin 1 mm section HRCT scans 4 6 8 10 12. Using HRCT scans and reformatted images of the optic canal region, Seiff et al 6 detected six patients having OCF out of nine patients with sudden blindness resulting from indirect TON.…”

Hyperintense Optic Nerve due to Diffusion Restriction: Diffusion-Weighted Imaging in Traumatic Optic Neuropathy

“…1 Clinical diagnosis of posterior TON is based on the presence of a relative afferent pupillary defect, decreased visual acuity (VA), normal funduscopic examination findings, and no apparent intraocular pathology. [2][3][4] The focus of this study was limited to posterior TON. Contusion, necrosis, concussion, hemorrhage, nerve fiber tears, and infarction due to vascular thrombosis or spasm have all been implicated as potential mechanisms of TON.…”

Treatment Outcomes following Traumatic Optic Neuropathy

“…This may be attributable to an attenuation of the absorptive capacity with the elderly facial anatomy, as bone is subject to atrophy, 27 ligamentous sling structures of the globe are prone to laxity, 28 and posterior intraconical fat diminishes, leaving the space susceptible to fluid accumulation. 29,30 Age correlates with atherosclerosis 31 and may exacerbate perfusion to an already compromised optic nerve during facial trauma. 32 These explanations remain theoretical, and differences in the elderly versus young patients warrant higher powered investigation.…”

“…Our group is prone to earlier operative fracture reduction, which may inadvertently offer relief of increased intraorbital pressure and decompress the extracanalicular optic nerve. 29,30 Because the effectiveness of optic nerve decompression is considered equivocal, risks of damage to the optic nerve and the ophthalmic artery, cerebrospinal fluid leak, and meningitis have deterred our surgeons from performing the procedure for indirect traumatic optic neuropathy.…”