A study of medical management of traumatic optic neuropathy

 

Abstract               Traumatic optic neuropathy (TON) is one of the devastating complications of head injury. It is noted in 0.5 to 3% of head injuries. Objectives of the study is whether medical treatment with steroid is useful or not. Totally 100 patients were included in this study In this study. patients who received Steroid alone were treated with high dose Inj. Methylprednisolone which was later tapered and stopped. The Study concludes that in steroid alone group, the improvement of vision was not statistically significant.

Key Words; head injuries, inj.methylprednisolone, traumatic optic neuropathy

 

 

INTRODUCTION

Traumatic optic neuropathy (TON) is one of the devastating complications of head injury. It is noted in 0.5 to 3% of head injuries. According to the studies, the incidence of optic nerve injury in head injury is 1.5%.Exact incidence of TON is difficult to determine, as many unconscious severe and critical head injured patients may die. Majority of optic nerve injuries happened because of acceleration and deceleration injury. The incidence was common among young adult males .RTA is the most frequent cause for TON, followed by falls and assaults. The optic nerve injury is often associated with significant head injury and faciomaxillary injury. Optic nerve injury can be divided into direct or indirect injury . The direct injury results from sharp object trauma, in which damage to the optic nerve occurs due to penetrating injuries, optic nerve avulsion or due to laceration caused by bony fragments. Whereas indirect injury is caused by transmission of shock waves or forces from a distant site to the optic nerve. Indirect injuries are more common than direct injuries in head injury patients. The prognosis of direct injury is very poor.

 

AIMS AND OBJECTIVES OF THE STUDY

Aims of the study

1. To study optic nerve injury in mild and moderate head injury patients admitted in the head injury ward, Rajiv Gandhi Government General Hospital.
2.  To study the role of medical management

Objectives of the study

1. Medical treatment with steroid useful or not

 

MATERIAL AND METHODS

Nature of study: Prospective study

Total cases studied: 100

Place of study: Head injury ward, Institute of Ophthalmology, Rajiv Gandhi

Government General Hospital, Chennai.

Time of study: August 2013 to March 2016.

In this study, patients who received Steroid alone were treated with high dose Inj. Methylprednisolone which was later tapered and stopped.

OBSERVATION AND RESULTS

In steroid alone group, about 54 patients were treated, but the improvement of vision was not statistically significant. ‘P’ value was >0.05 Medical treatment and visual acuity improvements.

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Figure 1:

 

DISCUSSION

The benefits of high dose of steroids was first observed in animal studies with brain edema induced by injury. Then many authors thought that corticosteroids reduces neural tissue edema by reducing oxygen free radical formation, stabilizing lipid membranes, reducing vasospasm, by increasing blood supply, and by preventing necrosis. This hypothesis made clinical introduction of high dose of steroids for acute spinal cord injury. NASCIS trial (National Acute Spinal Cord Injury Study) was a multicentric randomized control trial to assess the benefits of mega dose of steroid in acute spinal cord injury.

 

CONCLUSION

The Study concludes that in steroid alone group, the improvement of vision was not statistically significant.

 

REFERENCES