Walsh & Hoyt: Traumatic Optic Neuropathies: Management

The management of traumatic optic neuropathy should be guided by the Hippocratic adage to do no harm. Almost all case reports and most case series of traumatic optic neuropathy present treated cases. The older series are biased toward cases with severe visual loss. Contemporary studies contain much larger numbers of patients with mild optic nerve injuries. Consequently it is very difficult to use the retrospective data in the literature to characterize the natural history of traumatic optic neuropathy, making meaningful meta-analysis difficult. Without an accurate knowledge of the natural history of this injury, measuring the beneficial effect of a medical, surgical or combined approach is very difficult. This section will critically review the studies that are in the literature and summarize what is currently known concerning the clinical management of traumatic optic neuropathy.