The prevalence, profile and outcomes of traumatic optic nerve injury in the neurosurgical patients admitted to a tertiary care centre in south India in one year

Objectives: To find the prevalence of traumatic optic nerve injury in neurosurgical patients admitted to this rural tertiary care hospital and to assess the clinical profile and visual outcomes in these patients. Materials and Methods: This case series of the prevalence, profile and outcomes of patients with Traumatic optic nerve injury (TONI) admitted to the neurosurgical department of this rural teaching hospital during the year 2014 received the approval of the Institutional Review Board and the Institutional Ethics Committee. Data was accessed from the medical records of these patients for one year. Results: Of the 3466 neurosurgical admissions, 15 were found to have traumatic optic nerve injury making the prevalence of TONI in this institution 0.43%. Of the 15 patients with TONI, 14 (93%) were males and the mean age was 33 years and more than half were over the age of 30 years. Road Traffic Accidents remained the main cause for TONI (93%). Ten of these patients (66.7%) presented with fracture skull or orbit and 5 (33.3%) had no fractures. Most of the bony injuries were lateral orbital wall fractures accounting for 7 (70%). None of the patients had evidence of optic nerve compression. Fourteen of the 15 patients with TONI (93%), received intravenous and oral corticosteroids and one patient was treated conservatively. Twelve patients showed improved visual acuity on discharge while three did not improve. Conclusion: Traumatic optic nerve injury is a vision-endangering condition which is a comorbidity of blunt head trauma. Most of the patients with optic nerve injury presented with periorbital edema, subconjunctival haemorrhage and orbital wall fracture, lateral orbital wall fracture being the commonest. Patients treated with intravenous corticosteroids followed by oral route of the same were found to have good visual outcomes. There is a great need to develop clinical databases for better understanding of the natural history and management of this condition.