Indirect optic nerve trauma.

This report summarizes the details of 33 personal cases of the important but uncommon entity of posttraumatic optic neuropathy, seen during an 11-year interval. Victims were predominantly young males, and bicycles proved the most common source of injury. Severity of visual loss correlated poorly with level of consciousness and presence of craniofacial fractures. Optic canal fractures were found in only seven of the patients. Vision improved in five of 25 untreated patients, one of four treated with corticosteroids, and three of four treated with corticosteroids and transethmoidal decompression of the optic canal. No patients lost vision after their initial examination. Two of six initially blind eyes regained some vision. Management of these injuries is controversial. Hospitals should designate physician teams that should develop and implement a treatment plan for traumatic optic neuropathies.