Optic nerve injury, often termed traumatic optic neuropathy in the literature, can be divided into two main forms based on the mode of trauma. The direct injury is characterized by the primary damage to the optic nerve through compression, avulsion or transection, while the indirect injury is seen after significant trauma to the cranium and the structures surrounding the optic nerve (most commonly the orbit) [1] [2] [3] [4]. Sharp penetrating objects are responsible for direct optic nerve injuries, while head trauma is the main mode of indirect optic nerve injury, which is much more commonly encountered in clinical practice [1] [3] [5] [6]. The clinical presentation is not always proportionate to the severity of trauma [3]. Decreased visual acuity, together with a defect in light perception related to the affected eye, are main signs of the optic nerve damage [5]. Furthermore, loss of vision may be partial, but also total and lead to blindness in most severe injuries [1] [4] [6]. The onset of symptoms is almost instantaneous after trauma, but a slowly progressing course might also be noted [6]. In the absence of an early diagnosis of treatable cases, atrophy of the nerve will occur within weeks or months, suggesting that early recognition is vital [5].

• Falling

  Specific Falling over backwards. Rising up in starting gates, trailers or stocks with low ceilings. Pathophysiology Associated with skull trauma following backward falls or raising head upwards. Retrobulbar stretching and damage to optic nerve. [vetstream.com]

  In half of the children, injury was due to fall from a height. Fracture of the skull was recorded in a third of the patients, and optic canal fracture was seen only in three children. [ncbi.nlm.nih.gov]

  The severe impact can happen in accidents involving: flying debris, slips and falls, moving vehicles, bicycles, workplace mishaps, explosions and participation in sports activities. [rosenfeldinjurylawyers.com]

  A 64-year-old man with left-sided TON following a fall. [ajnr.org]

  Trauma to the optic nerve can be caused by falls, car accidents, sports injuries, or being punched or kicked in the eye. Trauma in close proximity to the optic nerve can also cause problems. [study.com]

• Ecchymosis

  An examination of the left eye also showed proptosis, subconjunctival hemorrhage and ecchymosis, hence emergency lateral canthotomy and orbital massage were performed at that medical center. [synapse.koreamed.org]

  […] pupillary defect (RAPD) OS Intraocular pressure: 14 mmHg OD, 16 mmHg OS by Tono-pen Confrontation visual fields: Full OD; unable to count fingers OS Motility: Full OD; -2 supraduction and abduction OS, otherwise full OS External : Periorbital edema and ecchymosis [webeye.ophth.uiowa.edu]

• Fatigue

  The physical demands of looking at an object or toy for a long period of time may cause eye fatigue. Allow a child with ONA to rest between activities requiring vision. [tsbvi.edu]

• Choking

  This pressure can "choke" the optic nerves, cutting off blood circulation. The damage to the nerves can be severe, Moshirfar says. The resulting problems can cause vision loss severe enough to lead to complete blindness. [everydayhealth.com]

• Fracture

  Ethmoid fracture was recorded in 2 patients and optic canal fracture was recorded in one patient. CT scanning for optic canal and for the orbit revealed abnormality in none of these patients. [ncbi.nlm.nih.gov]

  Fracture of the roof of the optic canal with frequent extension into the roof of the orbit has been documented. Fractures of the base of the skull may extend into the optic canal. [thamburaj.com]

  Radiography demonstrated contusional hematoma and pneumocephalus in the right frontal lobe, depressed fracture of the right temporal bone and fractures of right orbital walls. [jstage.jst.go.jp]

• Contusion

  A case is described in which optic nerve injury is caused by a sudden traumatic duction of the eyeball, with all signs of local or systemic contusion missing. [ncbi.nlm.nih.gov]

  In the majority of cases, the cause is a direct tear or contusion. [thamburaj.com]

  [Contusion of the optic nerve after minor blunt ocular trauma: case report and literature review]. Ophthalmologe. 1999 Aug; 96(8): 529–33. 6. Mackiewicz J, Machowicz-Matejko E, Sałaga-Pylak M, Piecyk-Sidor M, Zagórski Z. [aaem.pl]

  Acute ischemia and contusions in the brain parenchyma and spinal cord present as hyperintense signal on DWI at measurements with large b -values, and the calculated ADC map shows decreased diffusivity. 17, 18 Although contusion-related necrosis and ischemia [ajnr.org]

  Since the vasculature of the optic nerve in the canal is pial, compression and contusion of the nerve produce a compartment syndrome whereby swelling exacerbates the ischaemia. 5 The optic nerve is also vulnerable to a shearing injury under the fixed [nature.com]

• Unilateral Blindness

  A case of unilateral blindness following blunt injury to the skull is presented. The patient died 4 days after the initial injury, presenting the rare opportunity of a detailed histopathological study of the acute features of the condition. [ncbi.nlm.nih.gov]

  This should not be mistaken for a unilateral dilated pupil indicating an intracranial hematomas. With light thrown into a blind eye, the direct reflex is lost in both the eyes while the consensual reflex is preserved. [thamburaj.com]

• Blurred Vision

  In the later stages of glaucoma, however, the symptoms include loss of peripheral vision, eye pain, and blurred vision. Kelly doesn't have loss of peripheral vision, eye pain, or blurred vision, so glaucoma is probably not the culprit. [study.com]

  Optic Neuritis and Optic Neuropathy Call for an Appointment Duke’s neuro-ophthalmologists are subspecialists who conduct extensive evaluations to identify the cause of visual concerns including unexplained visual loss, blurred vision, and blind spots [dukehealth.org]

• Meningism

  With its meningeal sheath, the optic nerve is 3-4 mm in diameter and its total length measures approximately 50 mm from the globe to the optic chiasm. [emedicine.medscape.com]

  Nerve diseases that can cause ON include: MS neuromyelitis optica Schilder’s disease (a chronic demyelinating condition that begins in childhood) Infections that may cause ON include: mumps measles tuberculosis Lyme disease viral encephalitis sinusitis meningitis [healthline.com]

  Complications Serious surgical complications specific to decompression surgery for TON include infection (meningitis), CSF leaks, and exacerbation of traumatic optic neuropathy. [eyewiki.aao.org]

  As this fracture may open the sphenoid sinus, post-traumatic meningitis may result. [thamburaj.com]

Optic nerve injury can be initially recognized through a detailed patient history and a careful clinical examination. In the presence of vision-related complaints, physicians should reveal if there was any recent trauma that could have led to optic nerve injury. A complete inspection of the head and a complete ocular exam (including visual acuity testing, assessment of the visual field, and direct ophthalmoscopy) are highly useful in raising clinical suspicion [2]. One of the key procedures in solidifying the diagnosis is the use of visual evoked potentials (VEP), which uses electrical signals to determine the viability and status of the optic nerve [2] [6]. In addition to clinical criteria and VEP, imaging studies are also considered as vital components in workup, particularly in the setting of indirect optic nerve injury. Computed tomography (CT) and even plain radiography are highly useful in assessing the soft tissue and skeletal structures surrounding the optic nerve, but CT is favored due to its ability to provide a more detailed view of the anatomical landmarks in the cranium [2] [6] [7] [8]. In addition, magnetic resonance imaging (MRI), especially diffusion tensor imaging procedure, can also be employed, but only in the absence of contraindications (eg. lodged bullets or other interfering foreign bodies that are present in the endocranium) [2] [3] [8].

Due to timely treatment, the remaining 2 patients had a better prognosis. [ncbi.nlm.nih.gov]

However, in the literatures, there is no treatment of TON that can be surely expected to improve visual acuity. So the management of TON has remained controversial. [jstage.jst.go.jp]

Due to timely treatment, the remaining 2 patients had a better prognosis. [ncbi.nlm.nih.gov]

It addresses diagnosis, pathophysiology, management and prognosis and is written in a clear, concise style for quick, easy reference in the clinic. [books.google.com]

Written by over 100 acknowledged leaders in the field, and containing hundreds of tables, graphs, and photographic images, the text deals with issues of neuroimaging and neurodiagnostic testing, prognosis and outcome, acute care, rehabilitative care, [books.google.de]

Conclusion: Recovery of VEP from no response to abnormal wave or abnormal wave to normal VEP were indicators of relatively good visual prognosis. Overall, 23 patients showed visual improvement, but did not return to normal. [ijo.in]

Pathogenesis Etiology Skull trauma. Predisposing factors General Skull trauma particularly to occipital crest. Specific Falling over backwards. Rising up in starting gates, trailers or stocks with low ceilings. [vetstream.com]

ETIOLOGY 6. CLASSIFICATION 7. DIRECT INJURIES  Result from objects that penetrate the orbit and impinge on the optic nerve causing optic neuropathy by partial or complete transection of the optic nerve sheath. [slideshare.net]

Etiology The most common cause of TON is indirect injury to the optic nerve, which is thought to be the result of transmitted shock from an orbital impact to the intracanalicular portion of optic nerve. [eyewiki.aao.org]

Although the etiology of the increased risk of death was not determined, the findings of this study should be taken into consideration when managing cases of TON with concurrent traumatic brain injury. [clinicaltrials.gov]

They stated that future research should focus on increasing the understanding of the etiology and prognosis of NAION; new treatment options should be examined in the context of randomized clinical trials. [aetna.com]

[…] features include: Emphasis on a disease state management approach to patient assessment and treatment Promotion of a holistic, biopsychosocial model of patient assessment and care Review of current expert consensus on practice guidelines Exploration of epidemiologic [books.google.de]

Epidemiological trends of traumatic optic nerve injuries in the largest Canadian adult trauma center. J Craniofac Surg. 2012 Mar; 23(2): 516–20. 4. Balla L, Ianovici N, Costin D. Pathology of the optic nerve injury. [aaem.pl]

EPIDEMIOLOGY  Traumatic optic neuropathy occurs in 0.5-5 % of patients presenting with closed head trauma and in 2.5 % of patients presenting with midfacial fracture  Young > Old  Males > Females Steinsapir KD, Goldberg RA. [slideshare.net]

Diagnosis: Indirect traumatic optic neuropathy with dramatic spontaneous improvement BOXES: Epidemiology 85% male, mean age 34 years 0.5-5.0% of all closed head injuries 49% due to motor vehicle or bicycle accidents 27% due to falls; 13% due to assault [webeye.ophth.uiowa.edu]

The pathophysiology of indirect injury to the optic nerve under these circumstances is uncertain, but the lesions in this patient seemed to be due to ischemia. [ncbi.nlm.nih.gov]

It addresses diagnosis, pathophysiology, management and prognosis and is written in a clear, concise style for quick, easy reference in the clinic. [books.google.com]

[…] on a disease state management approach to patient assessment and treatment Promotion of a holistic, biopsychosocial model of patient assessment and care Review of current expert consensus on practice guidelines Exploration of epidemiologic and basic pathophysiologic [books.google.de]

Pathophysiology Associated with skull trauma following backward falls or raising head upwards. Retrobulbar stretching and damage to optic nerve. [vetstream.com]

AIM: To determine the role of rutin in prevention of cisplatin induced retinal and optic nerve injury in an experimental study. [ncbi.nlm.nih.gov]

Many causes of optic nerve atrophy cannot be prevented. Prevention steps include: Older adults should have their provider carefully manage their blood pressure. Use standard safety precautions to prevent injuries to the face. [medlineplus.gov]

C). prevent metal poisoning. D). all of the above. Answers: 1. D; 2. D; 3. C; 4. D. References supplied. 6 April 2017 [glaucoma.org.au]

1. Carta A, Ferrigno L, Salvo M, Bianchi-Marzoli S, Boschi A, Carta F. Visual prognosis after indirect traumatic optic neuropathy. J Neurol Neurosurg Psychiatry. 2003;74(2):246-248.
2. Singman EL, Daphalapurkar N, White H, et al. Indirect traumatic optic neuropathy. Mil Med Res. 2016;3:2.
3. Lee KF, Muhd Nor NI, Yaakub A, Wan Hitam WH. Traumatic optic neuropathy: a review of 24 patients. International Journal of Ophthalmology. 2010;3(2):175-178.
4. Samardzic K, Samardzic J, Janjetovic Z, Samardzic I, Sekelj S, Latic-Hodzic L. TRAUMATIC OPTIC NEUROPATHY - TO TREAT OR TO OBSERVE?Acta Inform Med. 2012;20(2):131-132.
5. Lee V, Ford RL, Xing W, Bunce C, Foot B. Surveillance of traumatic optic neuropathy in the UK. Eye (Lond). 2010;24(2):240-250.
6. Selvaraj VK, Viswanathan R, Devanathan V. Traumatic Optic Neuropathy – A Conundrum. J Clin Diagn Res. 2016;10(3):OD01-OD02.
7. Rajiniganth MG, Gupta AK, Gupta A, Bapuraj JR. Traumatic Optic Neuropathy. Arch Otolaryngol Head Neck Surg. 2003;129:1203–1206.
8. Kubal WS. Imaging of orbital trauma. Radiographics. 2008;28(6):1729-1739.