Traumatic optic neuropathy in pediatric population: Early intervention or delayed intervention?
Introduction
Optic nerve injury, an uncommon entity, is reported in 0.5–5% of the cases of closed head injuries but the incidence is on the rise due to increasing incidence of high speed motor vehicle accidents. The acute onset of the vision loss, the often complicated circumstances of the injury, the role of multiple disciplines and ill defined management protocol have led to interest in the condition [1]. The management protocol is better defined in the adult population but its applicability to the pediatric population is not well defined. There are only a few studies in the English literature which have dealt with pediatric traumatic optic neuropathy [2], [3]. We here report our experience of combined therapy protocol on 31 pediatric cases of traumatic optic neuropathy.
Section snippets
Patients and methods
In this prospective study, 31 children between the age group of 4 years to 15 years who presented to the emergency services department of otolaryngology with clinical features of traumatic optic neuropathy over around 4-year-period (January 2002–March 2006) were included. The mode of injury and the interval between the injury and the arrival to our hospital were recorded. The patients’ visual status was evaluated at initial presentation. Computed tomography (CT) scan of the head and the orbit
Results
Out of the 31 children, there were 21 males and 10 females. The age ranged from 4 years to 15 years with a mean age of 9.67 years. The etiology was head injury as a result of fall from height in 26 cases (83.87%) and blunt trauma to the head in 4 cases (12.9%) during recreational activities and as a result of intranasal injury by a blunt object in one of the cases (3.23%). Right side was affected in 17 cases and left in 14 cases. Cases were divided into three groups on the basis of the interval
Surgical procedure
All the cases were operated under general anesthesia with hypotension and with 15° head end elevation. The nasal cavity was decongested using xylocaine with adrenaline in a concentration of 1:1,00,000. The middle turbinate was medialized and bulla was opened, ground lamella was then entered, posterior ethmoids and then the sphenoid sinus was entered and sinus ostium was widened in the inferomedial direction and lateral wall bone was removed in the region of the optic canal in whole of the
Discussion
The relationship between frontal trauma and vision loss in the absence of ocular injury was appreciated by the 18th century. In the late 1800s, battle first distinguished penetrating from non-penetrating indirect optic nerve injuries [4]. Trauma-induced injury to the optic nerve can occur anywhere along the nerve's intraorbital to intracranial course. The hallmark of any optic neuropathy, traumatic or otherwise, is loss of visual function. This loss can manifest as subnormal visual acuity,
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Cited by (21)
Case report of rare blinding indirect traumatic optic neuropathy
2019, Journal Francais d'OphtalmologieEvaluation of transcranial surgical decompression of the optic canal as a treatment option for traumatic optic neuropathy
2015, Clinical Neurology and NeurosurgeryCitation Excerpt :In our study, surgical intervention helped in the recovery of vision acuity in 85.7% of the children; this value is remarkably higher than the average effect (P < 0.01). The structure of the bony canal of children is smaller than that of adults because of which there is lesser area for the nerve to expand [16]. Thus, intervention should be performed as early as possible rather than waiting for spontaneous recovery.
Facial fractures in children
2014, Otolaryngologic Clinics of North AmericaCitation Excerpt :Traumatic optic neuropathy may be discovered, which would warrant aggressive steroid therapy. If visual acuity does not respond or if bony fragments impinge on the optic canal, optic nerve decompression can be considered, although results have been mixed in pediatric trauma patients.37,38 Fractures of the orbital floor remain controversial in regard to which ones require repair.
A 2-year prospective surveillance of pediatric traumatic optic neuropathy in the United Kingdom
2012, Journal of AAPOSCitation Excerpt :Our study results are compared to other published pediatric TON studies in e-Supplement 2 (available at jaapos.org). Falls appeared to be a much less common cause of injury (19%) in our series than in the two Indian series, in which 50%14,15 and 84%9 of cases were due to falls from a height. Goldenberg-Cohen and colleagues16 reported a retrospective series of 40 cases from the United States, in which sports injuries showed a similar prevalence (22%), although there was a much higher rate of traffic accidents in the US cohort (62%) compared to 15.5% of cases in our BOSU cohort.
Orbit and Orbital Apex
2011, Otolaryngologic Clinics of North AmericaCitation Excerpt :The degree of force required to cause TON varies greatly and it can manifest as a result of minor trauma.27,33 In the pediatric population the majority of cases are caused by falls.34 TON is a clinical diagnosis using the history of the trauma and examination.
Anatomical Study and Clinical Application of Optic Canal Decompression Via Transethmoid-sphenoid Approach under Endoscope
2023, Journal of Craniofacial Surgery