Treatment Outcomes following Traumatic Optic Neuropathy

Sosin, Michael; Cruz, Carla De La; Mundinger, Gerhard S.; Saadat, Sean Y.; Nam, Arthur J.; Manson, Paul N.; Christy, Michael R.; Bojovic, Branko; Rodriguez, Eduardo D.

doi:10.1097/prs.0000000000001907

Cited by 28 publications

(22 citation statements)

References 32 publications

(35 reference statements)

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“…Direct TON results from anatomical damage to the optic nerve by penetrating trauma or bony laceration. Indirect TON results from optic nerve damage secondary to compression or swelling from transmission of high velocity force from a distant site 1417. This transmission of force is highlighted by patients 9, 18, and 27 of Group 1, who demonstrate indirect TON as a result of sheer force transmitted to the optic nerve contralateral to the side of fracture(s).…”

Section: Discussionmentioning

confidence: 99%

“…Recovery of visual acuity was not recorded for this study. Many trauma patients with TON often do not return for follow-up due to expiration or choices beyond our control, making outcomes difficult to document 14. If an appropriately powered patient population could be followed up, a future prospective study might correlate fracture pattern with posttraumatic visual acuity to identify which fracture patterns portend a more favorable prognosis and would contribute strongly to the literature, perhaps changing practice patterns.…”

Section: Discussionmentioning

confidence: 99%

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Facial Fracture Patterns Associated with Traumatic Optic Neuropathy

Kelishadi¹,

Zeiderman

Chopra³

et al. 2019

Craniomaxillofacial Trauma & Reconstruction

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Traumatic optic neuropathy (TON) is rare. The heterogeneity of injury patterns and patient condition on presentation makes diagnosis difficult. Fracture patterns associated with TON have never been evaluated. Retrospective review of 42 patients diagnosed with TON at the R. Adams Cowley Shock Trauma Center from May 1998 to August 2010 was performed. Thirty-three patients met criteria for study inclusion of fracture patterns. Additional variables measured included patient demographics and mechanism. Cluster analysis was used to form homogenous groups of patients based on different fracture patterns. Fracture frequency was analyzed by group and study population. Visual depiction of fracture patterns was created for each group. Cluster analysis of fracture patterns yielded five common “groups” or fracture patterns among the study population. Group 1 ( n = 3, 9%) revealed contralateral lateral orbital wall (100%), zygoma (67%), and nasal bone (67%) fractures. Group 2 ( n = 7, 21%) demonstrated fractures of the frontal bone (86%), nasal bones (71%), and ipsilateral orbital roof (57%). Group 3 ( n = 14, 43%) involved fractures of the ipsilateral zygoma (100%), lateral orbital wall (29%), as well as frontal and nasal bones (21% each). Group 4 ( n = 5, 15%) consisted of mid- and upper-face fractures; 100% fractured the ipsilateral orbital floor, medial and lateral walls, maxilla, and zygoma; 80% fractured the orbital roof and bilateral zygoma. Group 5 ( n = 4, 12%) was characterized by fractures of the ipsilateral orbital floor, medial and lateral orbital walls (75% each), and orbital roof (50%). A notably high 15 of 33 patients (45%) sustained penetrating trauma. Our study demonstrates five fracture pattern groups associated with TON. Zygomatic, frontal, nasal, and orbital fractures were the most common. Fractures with a combination of frontal, nasal, and orbital fractures are particularly concerning and warrant close attention to the eye.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Facial Fracture Patterns Associated with Traumatic Optic Neuropathy

Kelishadi¹,

Zeiderman

Chopra³

et al. 2019

Craniomaxillofacial Trauma & Reconstruction

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show abstract

“…20,25) The site of injury causing blindness is typically the forehead or supraorbital ridge, and less commonly may be the temporal region. 20,23) of vision. According to a study by Ansari 2) , in which a total of 2,503 patients were enrolled, retrobulbar hemorrhage was thought to be the primary mechanism of blindness, followed by direct damage to the eyeball.…”

Section: Classification Of Tonmentioning

confidence: 99%

6 Traumatic Optic Neuropathy

2019

Clinical Pathways in Neuro-Ophthalmology

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“…20,25) The site of injury causing blindness is typically the forehead or supraorbital ridge, and less commonly may be the temporal region. 20,23) Recently, Magarakis et al 19) systematically reviewed the literature to identify specific facial bone fracture patterns associated with ocular injury, including blindness. The authors found that zygomatic-maxillary complex fractures were the most common type of injury complicated by loss of vision.…”

Section: Classification Of Tonmentioning

confidence: 99%