Walsh & Hoyt: Traumatic Optic Neuropathies: Differential Diagnosis

Causes of visual loss following trauma, other than traumatic optic neuropathy, must be considered. With a thorough history and complete ocular examination, the differential diagnosis of visual loss with disturbed pupillary function can be rapidly narrowed. An optic nerve injury can accompany other ocular injuries. If the obvious ocular injuries do not account for the loss of vision and altered pupillary function, traumatic optic neuropathy should be suspected. Traumatic optic neuropathy can follow trivial head injuries. One must also be wary of visual loss that is merely coincidental to trauma. Monocular visual loss may not be noticed until the individual has occasion to close the uninvolved eye. In this setting the patient may attribute the visual loss to a recent traumatic event. Deciding if the visual loss is coincidental or caused by recent trauma may be difficult. Any process that can result in visual loss may be coincidentally associated with a traumatic incident such as decompensation of a vascular aneurysm, orbital or optic nerve inflammation, anterior ischemic optic neuropathy, or acute sinus disease with orbital involvement.Atraumatic cavernous sinus fistula is usually accompanied by numerous orbital findings, permitting easy differentiation from traumatic optic neuropathy