Walsh & Hoyt: Traumatic Optic Neuropathies: Management - Surgical Considerations

Surgical intervention for traumatic optic neuropathy also remains empirical. Cromptons study suggests that a large percentage of intracanalicular injuries take place at the falciform dural fold. This is a location that will not benefit from optic canal decompression. However, it is possible that subsets of injuries might benefit from surgical intervention. For example, reduction of bone fragments impinging on the optic nerve is a compelling reason for surgical intervention, especially in cases of delayed visual loss, although these may represent untreatable injuries. The hypothesis that reducing the canal fracture benefits the injured nerve remains untested. The fracture may just be residual evidence of the forces imparted into the nerve at the moment of impact; lifting these fragments of bone may not provide any therapeutic benefit.