Walsh & Hoyt: Traumatic Optic Neuropathies: Management - Megadose Steroids

Anderson et al. introduced the use of high dose corticosteroids for the treatment of traumatic optic neuropathy based on salutary effects of corticosteroids in the treatment of experimental CNS injury. They proposed a treatment protocol formulated on their experiences in treating seven patients with traumatic optic neuropathy with a combination of corticosteroids and surgery. They advised initial treatment with corticosteroids (dexamethasone, 35 mg/kg/day). Surgery was advocated in cases of delayed visual loss that fail to improve with treatment and in cases with initial visual improvement followed by worsening of vision despite treatment. Three of six patients had return of vision on high dose corticosteroids. Four of their patients underwent transethmoid-sphenoid optic canal decompression. Postoperatively, vision returned in only one case. Since this study, subsequent studies have combined corticosteroid treatment with surgical intervention, making it difficult to determine the therapeutic value of a particular treatment. Additionally, the percentage of patients with no light perception vision in these studies is smaller that earlier studies. This most likely reflects the greater awareness of the condition and more aggressive recruitment of patients compared to earlier studies. This difference in recruitment biases these studies to better outcomes irrespective of treatment when comparison is made to earlier studies.