J Korean Ophthalmol Soc.  2016 Nov;57(11):1770-1776. 10.3341/jkos.2016.57.11.1770.

Clinical Manifestations and Prognosis of Patient with Traumatic Optic Neuropathy

• Shin GR
• Kim DH

• KMID: 2357734
• DOI: http://doi.org/10.3341/jkos.2016.57.11.1770

Abstract

PURPOSE
To investigate the clinical manifestations, management, ophthalmologic complications, and prognosis of traumatic optic neuropathy.
METHODS
A retrospective survey of 55 patients who visited Chosun Hospital from April 2009 to February 2016 was performed. The sex, age, causes, fracture characteristics, neurologic injury, and combined craniofacial bone fractures of patients who were diagnosed with traumatic optic neuropathy were statistically analyzed. Also, we investigated the rate of visual impairment in the patients with intracranial hemorrhaging and craniofacial fracture on radiologic examination and development of sensory strabismus.
RESULTS
Traffic accidents were the most common cause of traumatic optic neuropathy. Among the patients, more than 60% showed severe visual impairment of less than 0.1 that lasted until the final observation. Altitudinal visual defects were the most common visual field defect and presented as marginal atrophy and central scotoma. While intracranial hemorrhaging was showed in 52.4% of the patients, craniofacial fracture was observed in 90.5% of the patients. The initial visual acuity was decreased when the patient presented with orbital fracture located in the retrobulbar area. Intravenous high-dose steroid injection did not affect visual prognosis. Sensory strabismus occurred more commonly under conditions of poor initial vision (p = 0.007) or young age (p < 0.001).
CONCLUSIONS
Traumatic optic neuropathy in Korea has a high rate of initial visual impairment with poor prognosis of vision. In addition, high-dose intravenous steroid injection did not result in visual improvement.

Keyword

High-dose corticosteroid; Traumatic optic neuropathy; Visual prognosis

MeSH Terms

Accidents, Traffic
Atrophy
Fractures, Bone
Humans
Korea
Optic Nerve Injuries*
Orbital Fractures
Prognosis*
Retrospective Studies
Scotoma
Strabismus
Vision Disorders
Visual Acuity
Visual Fields

Figure

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  Figure 1. Initial visual acuity difference between the groups of patients classified by involvement of posterior wall fracture in craniofacial fracture. fx. = fracture; Post. = posterior. * Mann whitney U-test.

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  Figure 2. Initial and final visual acuity in group of patients classified by steroid treatment. * Wilcoxson signed rank test.

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