Dul M W
Optometry Service, Franklin D. Roosevelt Veterans Administration Medical Center, Montrose, New York.
Optom Clin. 1993;3(2):91-101.
Trauma to the optic nerve may be direct, such as from a penetrating object, or indirect, which may result despite lack of direct contact of an object with the nerve. Although indirect injury initially causes no change in the appearance of the nerve head, within a matter of weeks optic atrophy will be manifest. The pathophysiology of nerve damage is incompletely understood. Management is controversial; steroid therapy has been advocated, as has surgical decompression of the nerve. Indirect injuries affecting the optic nerve may also result from torsional rotation of the globe (avulsion) and from subdural or subarachnoid hemorrhage (Terson's syndrome). There is no treatment for optic nerve avulsion; the unaffected eye should be protected with appropriate eyewear. Hemorrhaging in the retina and vitreous in Terson's syndrome should be monitored for resolution and risk of retinal detachment. Computed tomography may be necessary if subarachnoid or intracranial hemorrhages are suspected.
视神经损伤可能是直接的，比如由穿透性物体导致，也可能是间接的，即使物体未直接接触神经也可能发生。虽然间接损伤最初不会引起视神经乳头外观的改变，但在几周内就会出现视神经萎缩。神经损伤的病理生理学尚未完全明了。治疗存在争议；有人主张使用类固醇疗法，也有人主张对神经进行手术减压。影响视神经的间接损伤也可能由眼球扭转旋转（撕脱）以及硬膜下或蛛网膜下腔出血（泰森综合征）引起。视神经撕脱无法治疗；应使用合适的眼镜保护未受影响的眼睛。对于泰森综合征中视网膜和玻璃体的出血，应监测其吸收情况以及视网膜脱离的风险。如果怀疑有蛛网膜下腔或颅内出血，可能需要进行计算机断层扫描。
