PURPOSE: Up to half of patients with traumatic optic neuropathy (TON) develop permanent vision loss. The optimal management of TON remains controversial. Here, we aim to identify craniofacial fractures associated with TON and investigate the efficacy of steroid therapy in the treatment of TON.
METHODS: We reviewed CT scans of patients after acute facial trauma at our trauma center from 2018 to 2022 to determine craniofacial fractures associated with TON. TON patient outcomes between 2013 and 2022 were analyzed to compare steroid treatment vs observation. Primary outcomes were improvement in visual acuity and time to improvement. Multivariate logistic and linear regressions were performed.
RESULTS: Of 2374 patients with acute facial fractures, 21 (0.9%) had TON. Sphenoid sinus fractures were associated with the greatest odds of TON (aOR [95% CI] 25 [9-68]) followed by LeFort III and naso-orbitoethmoid (NOE) fractures (aOR [95% CI] 13 [4-42] and 7 [2-24], respectively), compared with patients without these fractures. A total of 86 TON patients (96 eyes) were analyzed for treatment outcomes. Their median (IQR) follow-up was 9 (4-31) months. Patients treated with steroids were more likely to have improvement in visual acuity compared to those managed with observation (8/13 [61.5%], 27/83 [32.5%], P<0.05). Steroids were also associated with a 57-day quicker improvement in visual acuity compared to observation (B=-57.1, P=0.007).
CONCLUSION: TON should be considered in patients with sphenoid sinus fractures. Steroid therapy was associated with a more rapid improvement and a better visual acuity than observation for patients with TON.