Matthew J Rose
| Matthew J Rose |
Matthew J Rose
Brian Ford
Oral and Maxillofacial Surgery, University of Pennsylvania School of Dental Medicine
Introduction
Blindness following facial trauma is a rare but serious complication. Traumatic optic neuropathy (TON) is a condition in which vision loss is due to direct or indirect trauma to the optic nerve. Here we present a case of a 30-year-old female that was struck by a car while riding her bicycle who immediately lost vision in her right eye.
Methods
A systemic Review of related literature was completed using various keywords.
Results
The ability of the steroids to limit free radical oxidative injury and lipid degeneration is crucial to its nerve-saving properties.[9] The most commonly administered corticosteroid when deemed necessary is mega-dose (>5,400mg) IV methylprednisolone. Cementing the importance and efficacy of steroids in acute nerve injury was a 1990 study, referred to as the National Acute Spinal Cord Injury Study (NASCI) published in the New England Journal of Medicine. [10] The timing and duration of administration is also an important prognostic factor. If given within 8 hours of the injury and continued for 48 hours, better clinical outcomes were observed.[11] Inherently, patients being treated for TON are often accompanied by traumatic brain injury (TBI) as a result of the initial trauma. One study showed that there was an increased risk of death associated with TBI and corticosteroids.[12] They affirmed that corticosteroids must be avoided when managing patients with brain injuries. This study is in stark conflict with the NASCI study that many use as proof of the overall efficacy of corticosteroids in TON.
Conclusion
The overall lack of consensus and weakness of treatment success for conservative, surgical, and corticosteroid treatments offers little to guide physicians for the treatment of acute traumatic optic neuropathy. The literature has established repeatedly that there is limited success with surgical and corticosteroid intervention in TON following facial trauma. Further studies showing more of the same would fail to add any value to the medical literature.