Traumatic Optic Neuropathy

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  • Due to eye or head trauma


  • Relative Afferent Pupillary Defect (RAPD) in the affected eye
  • Initially normal optic disc, possibly slight disc swelling and retinal hemorrhages
  • Progression to optic atrophy after 3-6 weeks
  • Possible restriction of eye motility
  • Visual field defects


  • Emergency CT or MRI of the orbit: Rule out compression of the optic nerve by hematoma/bone fragment


  • Controversial (no treatment superior to observation)
  • Consider steroid therapy: Weak evidence!
    • Consider steroid therapy if the traumatic event occurred less than 8 hours ago
    • e.g. Solu-Medrol i.v. 1g/day for 5 days, then Spiricort p.o. 1mg/kg body weight for 1 week, then stop
  • Consider surgery if bone fragment in the optic nerve or nerve sheath hematoma is present


  • EyeWiki Traumatic Optic Neuropathy
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)