29 Traumatic Optic Neuropathy



10.1055/b-0039-171472

29 Traumatic Optic Neuropathy



Abstract


“Traumatic Optic Neuropathy” discusses injuries to the optic nerve, which are rare and may result from a variety of mechanisms. Direct injury to the optic nerve can be caused by penetrating orbital trauma, partial or complete avulsion, or an intraoptic nerve sheath hematoma. Indirect injury to the optic nerve can result from an optic canal fracture with contusion of the optic nerve or edema within the optic canal after a blow to the supraorbital area, or from an expanding intraorbital hematoma. Evaluation of the patient may be difficult, especially if the patient is unconscious. It is extremely important to exclude other causes of visual loss. Orbital decompression by immediate lateral canthotomy and inferior cantholysis, if indicated (e.g., in acute orbital compartment syndrome related to the development of a retrobulbar hematoma), must not wait for imaging studies. The treatment for posterior indirect traumatic optic neuropathy is determined on an individual basis.




29.1 Introduction


Injuries to the optic nerve are rare and may result from a variety of mechanisms:




  • Direct injury to the optic nerve.




  • Indirect injury to the optic nerve.




    • Optic canal fracture with contusion of the optic nerve or edema within the optic canal after a blow to the supraorbital area.



    • Expanding intraorbital hematoma (Fig. 29‑1e–h).

Fig. 29.1 (a) Direct optic nerve trauma from a knife. (b) An axial CT scan demonstrating severe orbital trauma after a motor vehicle accident with complete avulsion of both optic nerves. (c) An axial CT scan demonstrating a left intraoptic nerve sheath hematoma in a patient struck accidentally in the orbit with a pool cue. (d) The same patient referred after inappropriate blind stabs had been made in the upper eyelid in a vain attempt to drain an orbital hematoma. Complete visual loss occurred in this patient due to the development of the intraoptic nerve sheath hematoma.
Fig. 29.1 (e) A patient with a periorbital hematoma following a fall. (f) Lifting the ptotic eyelid revealed that the patient had proptosis, hyperglobus, and an extensive subconjunctival hemorrhage. (g) A coronal CT scan demonstrating an orbital floor blowout fracture (blue arrow) and an inferior orbital hematoma with blood filling the maxillary sinus. (h) A sagittal CT scan demonstrating marked proptosis, an orbital floor fracture, and a large subperiosteal hematoma (red arrow) extending to the orbital apex.

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May 11, 2020 | Posted by in Reconstructive microsurgery | Comments Off on 29 Traumatic Optic Neuropathy

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