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Traumatic Optic Neuropathy – Case Report with Discussion on Diagnostic Procedures and Therapy

Snježana Kaštelan orcid id ; Department of Ophthalmology, Dubrava University Hospital, Zagreb, Croatia
Antonela Gverović Antunica orcid id ; Department of Ophthalmology, Dubrovnik General Hospital, Dubrovnik, Croatia
Jasminka Salopek Rabatić ; Department of Ophthalmology, Dubrava University Hospital, Zagreb, Croatia
Marta Gotovac ; Department of Ophthalmology, Požega General Hospital, Požega, Croatia
Darko Orešković ; Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
Boris Kasun ; Stubičke Toplice Special Hospital for Medical Rehabilitation, Stubičke Toplice, Croatia

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page 166-172

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Traumatic optic neuropathy (TON) is a serious vision threatening condition that can be caused by ocular or head trauma. Indirect damage to the optic nerve is the most common form of TON occurring in 0.5% to 5% of all closed head trauma cases. Although the degree of visual loss after indirect TON may vary, approximately 50% of all patients are left with ‘light perception’ or ‘no light perception’ vision, making TON a significant cause of permanent vision loss. We present a 47-year-old male patient with a history of right eye keratoconus following a motorcycle crash. Visual acuity was of ‘counting fingers at 2 meters’ on the right eye due to keratoconus and ‘counting fingers at 1 meter’ on the left eye as a consequence of trauma. The Octopus visual field showed diffuse reduction in retinal sensitivity and the Ishihara color test indicated dysfunction of color perception on the left eye. Relative afferent pupillary defect was also present. Computed tomography revealed multifragmentary fracture of the frontal sinus and the roof of the left orbit without bone displacement. Based on the findings, conservative corticosteroid therapy without surgery was conducted. The patient responded well to treatment with complete ophthalmologic recovery.


Head injuries, closed, Optic nerve injuries, Eye injuries, Visual acuity, Diagnostic imaging, Keratoconus

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