2.1 Preoperative evaluation
Patients with traumatic optic neuropathy were admitted under
neurosurgery department and references to ENT department were sent at
least 24 hours after admission. However, most of these cases might
already be started on high dose corticosteroids. Patients were planned
for optic nerve decompression when there is radiological evidence of
fracture involving optic canal (Fig. 1) and failed medical management.
Patients with radiological evidence of fracture segment impingement on
optic nerve and deteriorating vision were straight away taken up for
EOND and not waited for medical decompression.
Ophthalmological evaluation for visual assessment (Table
I)10 and fundoscopy were done for these patients.
Fundoscopic examination may provide helpful information and avoid
unnecessary surgery. If this examination displays total atrophy of the
optic nerve (which indicate a pre existing pathology), there is no
reason for EOND, because restoration of vision is impossible. Complete
atrophy occurs 2 to 3 weeks after trauma. However, injuries to the
intraocular or intraorbital portions of the optic nerve result in
changes that may present very rapidly. Fundoscopic examination also is
very helpful in ruling out etiologies of decreased vision other than
injury to the optic nerve, such as retinal edema, choroidal rupture,
retinal detachment, or vitreous hemorrhage11. Relative
afferent pupillary defect which is a sign optic neuropathy is seen in
majority of these patients. All patients who were started on high dose
corticosteroids were observed for any visual improvement and not waited
for more than 72 hours so that further intervention may be planned as
early as possible. Those with improvement were continued with medical
management. But those with no improvement or with visual deterioration
were given the option of surgery. Some patients refused the surgery and
unfortunately some patients could not be taken right away for surgery as
they had other life threatening conditions to be treated and EOND had to
be prolonged for the well being of the patient. Hence such cases were
taken after 72 hours once the patient became stable for surgery.
Preoperative consent regarding visual improvement and prognosis were
obtained after discussing the possible complications. During the initial
years of our study patients who were taken up for optic nerve
decompression after 7 days with no light perception did not show any
improvement. Hence in the later years, such patients were excluded.