Should High Dose Corticosteroids be Abandoned in the Treatment of Post Traumatic Optic Neuropathy?: A Case Report
Lotfi Chaabani
*
Ophthalmology Department, Regional Hospital of Kasserine, Tunisia and Faculty of Medicine of Sousse, University of Sousse, Tunisia.
Yosra Doulemi
Ophthalmology Department, Regional Hospital of Kasserine, Tunisia.
Ksouri Saifeddine
Ophthalmology Department, Regional Hospital of Kasserine, Tunisia and Faculty of Medicine of Sousse, University of Sousse, Tunisia.
*Author to whom correspondence should be addressed.
Abstract
Aims: Post-traumatic optic neuropathy (TON) is an uncommon but potentially devastating complication of head trauma. Its management remains controversial, and the role of systemic corticosteroids is increasingly questioned. The aim of this report is to describe the clinical presentation and spontaneous recovery in a patient with TON.
Presentation of Case: We report the case of a 27-year-old male who sustained a head trauma following a road traffic accident, resulting in bilateral severe visual loss. Initial ophthalmologic examination revealed visual acuity limited to light perception in both eyes, with a relative afferent pupillary defect and normal anterior segments. Fundus examination showed a normal optic disc in the right eye and sectoral pallor in the left eye. Electrophysiological testing demonstrated delayed and reduced visual evoked potentials, and optical coherence tomography confirmed optic nerve fiber loss. Magnetic resonance imaging revealed an edematous contusion of the optic nerve within the optic canal, associated with a temporal contusion. Conservative management with close monitoring was adopted. At one-month follow-up, visual acuity improved to 10/10 in the right eye, while the left eye remained stable at light perception.
Discussion: TON primarily affects young adults, most often following high-energy trauma. Visual prognosis depends largely on initial visual acuity. The pathophysiology may involve optic canal fracture, microvascular injury, or direct nerve contusion. Management remains debated: neither surgical decompression nor high-dose systemic corticosteroids have demonstrated clear benefit, and corticosteroids may even be harmful. Our case illustrates the potential for spontaneous visual recovery under observation alone.
Conclusion: High-dose systemic corticosteroids are not recommended in TON due to their lack of efficacy and possible harmful effects. Careful monitoring and individualized management appear to be the safest strategy until further evidence clarifies optimal treatment.
Keywords: Traumatic optic neuropathy, visual outcome, optic nerve injury, corticosteroids, conservative treatment