Surgical treatment of progressive visual loss in traumatic optic neuropathy

Report of two cases

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✓ In two patients with traumatic optic neuropathy progressive visual loss was reversed by surgical decompression of the optic nerve sheath. The first patient with hemorrhage beneath the optic nerve sheath had progressive loss of vision from counting fingers to no light perception within 24 hours after the injury. Surgical evacuation of the hematoma improved visual acuity to 8/30. The second patient had progressive visual loss from 20/20 to 20/400 within the 1st week after injury. Drainage of an arachnoid cyst of the optic nerve sheath improved visual acuity to 20/25. Computerized axial tomography disclosed the hemorrhage in the first case and enlargement of the optic nerve sheath in the second. While the management of traumatic optic neuropathy is controversial, surgical intervention for an arachnoid cyst and hematoma involving the optic nerve is clearly beneficial.

Article Information

Address reprint requests to: John Guy, M.D., Neuro-Ophthalmology Service, University of Florida College of Medicine, Box J-284, JHMHC, Gainesville, Florida 32610-0284.

© AANS, except where prohibited by US copyright law.

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    Case 1. Axial computerized tomography scan revealing hemorrhage within the confines of the right optic nerve sheath.

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    Case 2. Asymmetric axial computerized tomography scans disclosing enlargement of the right optic nerve sheath (left), in comparison to the left optic nerve (right).

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    Illustrations of the medial orbitotomy technique. Left: Detachment of the medial rectus muscle from the globe gives access to the optic nerve sheath expanded by a hematoma or the contents of an arachnoid cyst (arrows). Right: An incision is made in the optic nerve sheath allowing drainage of its contents (arrows), thereby relieving pressure on the optic nerve. The medial rectus muscle is then reattached to the globe.

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