Optic Nerve Trauma: Medical Treatment

Visual loss may be produced by direct or indirect trauma to the optic nerve. Direct mechanisms produce gross to microscopic discontinuity of the nerve, i.e., its axonal com- . opponents. Direct injury can be produced by a diversity of insults, such as knife wounds, gunshot wounds, bone fragments impaling the nerve, displaced bony fracture involving the orbit or canal. Indirect mechanisms include stretching, tearing, torsion, or contusion secondary to sudden acceleration or deceleration of the globe tethered at the apex of the orbit; by skeletal deformation transmitted to the optic canal by contiguous bones leading to devascularization of the nerve, ischemia and compression secondary to raised intraorbital pressure or raised subarachnoid pressure, or vasospasm. Since there is a dearth of controlled experimental and clinical work dealing with optic nerve trauma, for the purposes of discussion I will make the ""blind"" leap of faith that the optic nerve can be considered a pure-white-matter central nervous system try t. Thus, it should be possible to interpolate data derived from experimental and clinical trials dealing with spinal cord and cortical trauma and apply lessons learned to the treatment of optic nerve trauma.