visual outcome of traumatic optic neuropathy in patients treated with intravenous megadose of steroids

although uncommon, traumatic optic neuropathy (ton) is an important cause of visual loss. different therapeutic approaches including different dosages of steroids, surgical decompression of optic canal and observation alone have been suggested but there has been no conclusive evidence to establish a standard approach to this devastating cause of visual loss. to determine the effectiveness of intravenous (iv) steroids in the treatment of these patients, the medical records of patients with ton, including one bilateral case, treated with iv steroids were reviewed. twenty-eight patients (22 males, 6 females) with mean age of 24.1 (11 to 41 years) were enrolled. all patients had received 30 mg/kg loading dose of methylprednisolone succinate followed by 5.4 mg/kg/ hour for 48 hours. visual acuity (va) was improved by ≥ 1 line in 8 eyes (28.6%) immediately after treatment and in 10 eyes (37%) after 3 months; however, most of them (6 and 8, respectively) were in the range of initial va of no light perception to hand motion. after adjustment for the baseline va, these improvements in visual acuities were not considered significant. neither different orbital fractures, nor various extraocular muscle palsies had any significant effect on the prognosis of ultimate va. regarding the natural course of ton, this investigation showed that iv megadose steroids had no clear benefit on the visual outcome of patients with ton.