Surgical decompression of the optic canal in a patient with traumatic optic neuropathy should be performed when there is a reasonable expectation of benefit.
Surgery is nonindicated if the patient has good vision on steroids that persists after taper, and no lesions requiring decompression on imaging studies.
|
Clinical Findings |
Absolute Contra-indication |
Relative Contra-indication |
Indication for Surgery |
|
patient unconscious |
|
yes |
|
|
Visual Decline or Loss |
Absolute Contra-indication |
Relative Contra-indication |
Indication for Surgery |
|
total loss, with loss of pupillary response |
|
yes |
|
|
decline in vision on tapering steroid dose |
|
|
yes |
|
visual loss develops despite steroid therapy |
|
|
yes |
|
deterioration in visual evoked potential (VEP) over time |
|
|
yes |
|
Changes Seen on CT Scan |
Absolute Contra-indication |
Relative Contra-indication |
Indication for Surgery |
|
optic nerve avulsion |
yes |
|
|
|
fracture of optic canal with potentially compressive bone fragment |
|
|
yes |
|
hematoma of optic sheath |
|
|
yes |
Specialty: Ophthalmology, Emergency Medicine, Surgery, general
ICD-10: ,
