June 5, 2020 Conference
Traumatic optic neuropathy and ocular motor dysfunction
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Dr. Crandall Peeler, Boston Medical Center (Presenter)
Some degree of vision loss due to optic nerve injury is thought to occur in 2-5% of all head injury cases (1). The most common mechanism of injury is “indirect,” with impact forces transmitted via bone from the brow to the optic foramen. These forces cause vision loss through compression, stretching, or contusion of the optic nerve but often leave no ophthalmoscopic or radiographic signs of injury in the acute phase (2). “Direct” injury to the optic nerve by penetrating objects entering the orbit or optic canal is less common but important to rule out as surgical intervention can sometimes recover vision in these cases. Ocular motor dysfunction from injury to cranial nerves III, IV, or VI may also occur in the setting of trauma. Cranial nerve IV is most susceptible to injury even from relatively mild head trauma given the close anatomic relationship of its posterior decussation to the tentorium. Cranial nerves III and VI may be injured in more severe head trauma from traction or disruption at their peripheral attachments to the skull base or centrally from brainstem shearing or hemorrhage. The aim of this talk is to provide an overview of traumatic optic neuropathy and ocular motor palsies with a focus on imaging and treatment options.