How should patients with indirect traumatic optic neuropathy be treated?
How should patients with indirect traumatic optic neuropathy be treated?
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DOI：
10.1097/wno.0b013e31821c9b11
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发表时间：
2011-06
期刊：
影响因子：
--
通讯作者：
Levin LA
中科院分区：
文献类型：
--
作者：
Volpe NJ;Levin LA
背景TON可由直接和间接创伤引起。为了讨论的目的，我们将间接TON定义为由于前额、眉毛或头部创伤导致的视神经病变，而不是视神经的直接或穿透性眼部或眼眶损伤。后者发生在脸部，特别是前额受到打击后，最常见于机动车事故或福尔斯（1）。推测的损伤机制涉及视神经管中视神经的挫伤。然而，只有大约三分之一的患者发现了视神经管骨折，因此，对于后间接TON的诊断，不需要识别骨折[5]。这种情况可能与任何程度的视觉功能障碍有关，但通常视力丧失是严重的。当视网膜受伤、眼内出血或眼睛或神经受伤的外部或初步检眼镜证据时，通常不会做出诊断（1）。TON通常伴有严重的头部损伤或多系统创伤，有时会使诊断变得困难，并且通常会妨碍收集以严格的方式研究各种治疗所需的有意义的临床信息。
BackgroundTON can result from both direct and indirect trauma. For the purpose of this debate, we define indirect TON as due to trauma to the forehead, brow, or head producing an optic neuropathy as opposed to direct or penetrating ocular or orbital injury to the optic nerve. The latter develops after blows to the face and particularly the forehead and most commonly in the setting of motor vehicles accidents or falls (1). The presumed mechanism of injury involves contusion injury to the optic nerve in the optic canal. Optic canal fractures however are identified in only approximately one third of patients, and therefore identification of a fracture is not necessary for the diagnosis of posterior indirect TON (5). The condition can be associated with any level of visual dysfunction, but generally vision loss is severe. The diagnosis is generally not made when there is injury to the retina, intraocular hemorrhage, or external or initial ophthalmoscopic evidence of injury to the eye or the nerve (1). TON often accompanies severe head injury or multisystem trauma, which at times can make establishing the diagnosis difficult and often precludes gathering meaningful clinical information necessary to study various treatments in a rigorous way.