Eye Injury: Optic Nerve

What is traumatic optic neuropathy?

Traumatic optic neuropathy is an injury to the optic nerve. The optic nerve is located behind the eye, and sends visual images to the brain. Injury to the optic nerve can happen anywhere along its path from the eye to the brain.

What is the cause?

Traumatic optic neuropathy can happen with any injury to the head or eye socket such as:

• car accidents
• assaults (including blunt objects, stab wounds and bullet or BB injuries)
• falls
• sports-related injuries
• complications of surgery in the eye socket, brain or sinuses

The optic nerve can be injured indirectly by:

• something hitting your head hard enough to send a shockwave through the bone or eye to the nerve. This can cause swelling in the nerve and loss of blood flow to the nerve.
• Bleeding, swelling, or air around the nerve anywhere along its path from the eye to the brain. This can put pressure on the nerve and damage it.

What are the symptoms?

Traumatic optic neuropathy causes vision loss in one eye that may worsen over several days. Your ability to see color may be decreased and light may be dimmer in the affected eye. You may notice that a part of your vision is missing. Depending on the type of injury, you may also have pain, swelling, and double vision.

How is it diagnosed?

Your healthcare provider will ask about your symptoms, examine your eyes, and do tests to identify the cause. Tests you may have are:

• an exam with a microscope to look at the front of your eye
• an exam of the way your pupils react to light. Traumatic optic neuropathy makes your pupil react abnormally to light
• a dilated exam using drops to make your pupil larger to look in the back of your eye
• photographs to document the appearance of your optic nerve
• a visual field test to test your peripheral field of vision (In this test, you are shown small bright spots of light in the corners of your vision and asked to press a button when you can see them.)
• a CT scan to look at the structures of your eye socket and brain, including the optic nerve.
• an MRI scan to look at your optic nerve and your brain (This test is usually done with a dye injected into your arm to highlight areas of inflammation. An MRI cannot be done until your healthcare provider is sure that you do not have any metal left over from your injury or from previous surgeries.)
• a VEP (visual evoked potential) may be performed to test the function of the nerve if you are too severely injured to participate in an exam (In this test, lights and patterns are shown to the eye and brain signals are recorded.)

You may need to be referred to a neuro-ophthalmologist (a doctor who works with the eye and its relation to the brain).

How is it treated?

The treatment of traumatic optic neuropathy depends on the type of injury you have had. If there is pressure on the nerve in the eye socket from blood, bone, or air, you may need surgery to relieve the pressure. You may also need eyedrops to lower the eye pressure. You may also be given steroid medicines through an IV. Your provider will explain which treatments are best for you.

How long will the effects last?

The outcome of traumatic optic neuropathy depends on the type of injury you have had and whether you have other injuries to the eye and/or brain. You may regain good vision. Or, if your injuries are severe, you may have permanent changes in your vision.

How can I take care of myself?

• Follow your treatment plan.
• Keep all appointments for provider visits or tests.

How can I help prevent traumatic optic neuropathy?

If you are injured and have visual symptoms, contact your healthcare provider right away.