Controversy in the management of traumatic optic neuropathy.

Traumatic optic neuropathy (TON) refers to any insult to the optic nerve secondary to trauma. The incidence of TON after traumatic head injury in various studies ranges from 0.5-2.3%. An impact injury to the optic nerve often resulting in significant visual loss and even blindness.The vast majority of TON cases are seen in males,around thirty years of age. TON can be classified depending on the mode of injury (direct or indirect). Spontaneous visual improvement was observed in 40-60% of cases. At this time, the beneficial roles of systemic corticosteroids and surgical optic nerve decompression, either alone or in combination, are inconclusions. Corticosteroids may increase mortality in acute traumatic brain injury, therefore be seriously considered in the subgroup of TON patients who have co-existing head injuries. Corticosteroids may also induce further axonal loss and cause worsening eyesight. Surgical optic nerve decompression may have benefit to a subset of patients but we do not yet know which patients are likely to benefit. Patients with progressive visual loss associated with the finding of intra-sheath hemorrhage may respond favorably to surgery. Patients without light perception who have no improvement after corticosteroid therapy, however, have very poor prognosis and may not be candidates for surgery. Thus the treatment of TON must be individualized.