To evaluate the clinical presentations of
traumatic optic neuropathy and to assess the visual outcome of three groups of patients managed differently (conservative, intravenous
corticosteroids only and combination of intravenous and oral
corticosteroids) at an academic tertiary care referral centre.
METHODS: Twenty-four patients (27 eyes) were included. All cases involved were males. Mean age was 33 years old. Motor vehicle accident was the major cause (83.3%). Both eyes were equally involved. Most of the eyes had poor vision on presentation (HM-NPL, 81.5%) with associated periorbital haematoma (22 eyes) and subconjunctival haemorrhage (20 eyes). Majority of patients (19 patients, 79.2%) presented with more than one bony fracture of skull or orbit and 5 patients (20.8%) had no fractures. None of the patients had evidence of optic nerve compression on CT scans or MRI done. Eleven patients (45.8%) had been treated with intravenous and oral
corticosteroids. The other 7 patients (29.2%) were treated conservatively and the third group (6 patients, 25.0%) was on intravenous
corticosteroids only. Eleven of 12 eyes (91.7%) treated with intravenous and oral
corticosteroids had shown 1 line improvement of visual acuity. Those eyes treated conservatively (77.8%) had shown 1 line improvement of visual acuity. As for patients treated with intravenous
corticosteroids only, four patients remained NPL, one patient had mild visual improvement and the other one's vision remained the same. The visual improvement in patients treated with
conservative management was not significant (P=0.386). Patients treated with intravenous
corticosteroids alone have shown no visual improvement statistically(P<0.05). Patients treated with intravenous followed by oral
corticosteroids had significant visual improvement (P<0.05). There was no statistically significant difference in visual outcome between patients treated with
corticosteroids and patients treated conservatively (P=0.368). No patient underwent
surgical decompression of the optic nerve. In this series, the follow up ranges from 6 months to 3 years.
CONCLUSION: