Interdisciplinary diagnosis and therapy of traumatic optic nerve damage

: Traumatic optic nerve lesions (TONL) still pose a large clinical problem concerning early detection and treatment. Neuro-ophthalmology provides reliable tests to detect afferent lesions but these methods are limited to just 30% of the severely injured patients. Especially in the patient with multiple injuries, optic nerve injuries are hardly predictable. In the latter group we established well-known neurophysiological methods for early detection of afferent disorders of the visual pathway, i.e. flash-VEP ERG. Apart from these diagnostic problems of TONL, controversy still surrounds the appropriate treatment of TONL--whether conservative or surgical or even combined treatment should be advocated. Our aim was to establish a reliable diagnostic schedule, based on the combination of neuro-ophthalmological, spiral-CT and clinical findings, and a treatment plan, so that in any patient there is a distinct guideline as to whether there is a need for early treatment of the peripheral visual pathway or not. In 52 patients who were assessed by the above-mentioned schedule, we could detect any of the 20 afferent disorders of the peripheral visual pathway. Although it is difficult to prove therapeutic effects on the injured optic nerve, immediate combined conservative treatment plus optic nerve decompression helped in three patients, who reported unilaterally no light-perception at admission, to regain at least partial recovery of afferent function of the visual pathway. Most of the trauma units still handle the problem of optic nerve trauma with a 'wait and see' policy. This is not regarded as an up-to-date option, since there are alternatives, and these will be outlined.