Miller Neil R
Department of Ophthalmology, Neurology & Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
J Neurol Surg B Skull Base. 2021 Feb;82(1):107-115. doi: 10.1055/s-0040-1722632. Epub 2021 Feb 2.
A host of different types of direct and indirect, primary and secondary injuries can affect different portions of the optic nerve(s). Thus, in the setting of penetrating as well as nonpenetrating head or facial trauma, a high index of suspicion should be maintained for the possibility of the presence of traumatic optic neuropathy (TON). TON is a clinical diagnosis, with imaging frequently adding clarification to the full nature/extent of the lesion(s) in question. Each pattern of injury carries its own unique prognosis and theoretical best treatment; however, the optimum management of patients with TON remains unclear. Indeed, further research is desperately needed to better understand TON. Observation, steroids, surgical measures, or a combination of these are current cornerstones of management, but statistically significant evidence supporting any particular approach for TON is absent in the literature. Nevertheless, it is likely that novel management strategies will emerge as more is understood about the converging pathways of various secondary and tertiary mechanisms of cell injury and death at play in TON. In the meantime, given our current deficiencies in knowledge regarding how to best manage TON, "primum non nocere" (first do no harm) is of utmost importance.
许多不同类型的直接和间接、原发性和继发性损伤可影响视神经的不同部分。因此，在穿透性和非穿透性头部或面部创伤的情况下，应高度怀疑存在创伤性视神经病变（TON）。TON是一种临床诊断，影像学检查常常有助于明确所讨论病变的全貌/范围。每种损伤模式都有其独特的预后和理论上的最佳治疗方法；然而，TON患者的最佳治疗方案仍不明确。事实上，迫切需要进一步研究以更好地了解TON。观察、使用类固醇、采取手术措施或这些方法的联合应用是目前治疗的基石，但文献中缺乏支持TON任何特定治疗方法的统计学显著证据。尽管如此，随着对TON中各种细胞损伤和死亡的二级和三级机制的汇聚途径有更多了解，可能会出现新的治疗策略。与此同时，鉴于我们目前在如何最佳治疗TON方面的知识不足，“首要的是不造成伤害”至关重要。
