Is there treatment for traumatic optic neuropathy?

Purpose of review: The purpose of this study is to discuss current controversies surrounding the proposed treatments for traumatic optic neuropathy (TON) and review recent evidence from the literature relating to these therapeutic options. Recent findings: No recent randomized controlled trials investigating surgical or medical interventions for TON exist. The current literature regarding treatment of TON consists mainly of small, mostly retrospective, observational studies. Treatment of TON with corticosteroids, surgical decompression of the optic canal or combinations of surgery and corticosteroids does not appear to offer improved visual outcomes compared with observation alone. Recent evidence suggests that there may be diminished functional reserve of the optic nerve following trauma. Novel neuroprotective therapies, such as erythropoietin, are currently under investigation in the treatment of TON. Summary: TON may lead to profound visual disability. Because of the absence of Class I evidence relating to treatment of TON, a lack of consensus exists among clinicians regarding the appropriate treatment for TON. Our review of the recent literature finds that there is still no reliable evidence that treatment of TON with corticosteroids, surgical optic canal decompression or both confers any benefit over observation alone, and yet these interventions incur an additional risk that may not warrant their routine use.