Walsh & Hoyt: Traumatic Optic Neuropathies: Epidemiology

Traumatic optic neuropathy occurs in association with high momentum deceleration injuries. Optic nerve injury is often associated with midface trauma. Table 9.1 lists the most common causes of traumatic optic neuropathy. Motor vehicle and bicycle accidents are the most frequent cause, accounting for 1763% of cases, depending on the series. Motorcycle accident victims may be particularly vulnerable to traumatic optic neuropathy. A consecutive series of 101 patients with head trauma after a motorcycle accident found 18 cases of traumatic optic neuropathy (18%) (10). Falls are the next most common cause, producing 1450% of cases. Traumatic optic neuropathy has also resulted from frontal impact by falling debris (11,12), assault (11), stab wounds (13), gun shot wounds (13,14), skateboarding (11), bottlecork injuries (15), following seemingly trivial injuries (3,16), and following endoscopic sinus surgery (1720). Iatrogenic optic nerve trauma with visual loss is rare following elective LeFort I osteotomy. When it does occur, it may be related to uncontrolled and unpredictable pterygomaxillary disjunction with propagation of the fractures into the optic canal (22).