Timing of endoscopic surgical decompression in traumatic optic neuropathy: a systematic review of the literature

Int Forum Allergy Rhinol. 2016 Jun;6(6):661-7. doi: 10.1002/alr.21706. Epub 2016 Jan 19.


Background: Traumatic optic neuropathy (TON) represents a rare but devastating complication of closed head injuries. No accepted guidelines are available for medical and surgical management algorithms. A systematic review of the literature was performed to determine the optimal timing and candidacy for endoscopic surgical intervention.

Methods: A systematic review of multiple databases was performed including Medline-Ovid, EMBASE, and PubMed. Data was extracted and patients stratified based on surgical delay from trauma (≤3 days, >3 days, ≤7 days, or >7 days) as well as preoperative and postoperative vision testing (no light perception [NLP]; light perception [LP]; hand motion [HM]; or finger counting [FC] or better).

Results: The literature review identified 24 studies meeting inclusion criteria. In the group of patients receiving surgery ≤3 days after the antecedent event, 57% (105/183) had visual improvement, whereas in the >7-days group 51% (145/283) of patients improved. In those with NLP preoperatively, 41% (172/411) saw improvement, whereas those with LP (89%), HM (93%), or FC (85%) fared better.

Conclusion: The literature suggests that surgical intervention for TON is indicated despite delayed presentation, and is a better choice than no intervention at all. Patients with complete blindness on presentation (NLP) tend to have a poorer surgical outcome.

Keywords: endoscopic sinus surgery; optic nerve decompression; optic nerve injury; optic neuropathy; surgical decompression.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Decompression, Surgical*
  • Endoscopy*
  • Humans
  • Optic Nerve Diseases / surgery*
  • Time Factors