Traumatic optic neuropathy and second optic nerve injuries

OBJECTIVE To assess vision improvement in patients treated by various methods who have a second incidence of TON. DESIGN, SETTING, AND PARTICIPANTS Retrospective medical record review of 12 patients with a second TON seen in an 18-year period (mean follow-up, 11.3 months) at a single tertiary care oculoplastic practice. INTERVENTIONS Observation, high-dose corticosteroids, optic nerve decompression, or high-dose corticosteroids plus optic nerve decompression. MAIN OUTCOMES AND MEASURES Change in vision on the Snellen eye chart. RESULTS All second TON events involved the same-side optic nerve as initially injured, and with observation alone, corticosteroids, or corticosteroids and partial optic canal decompression, all patients had vision improvement after their initial injury (P = .004). However, following the second optic nerve injury, most patients' vision fell to the pretreatment level of the first injury, and subsequent management of the second injury with corticosteroids and/or optic canal decompression provided little or no vision return (P = .05). In contrast, optic canal decompressions performed for 91 primary TON injuries resulted in 82.4%having some degree of vision improvement. CONCLUSIONS AND RELEVANCE Patients with TONmay have a second optic nerve insult, and vision recovery from the second event may be limited regardless of primary treatment choice.