TRAUMATIC OPTIC NEUROPATHY - TO TREAT OR TO OBSERVE?
We present a case of 54 year old male patient who got fist punched in the right eye by a coworker half an hour prior. He complained about the loss of vision in the right eye.\nHe did not loose consciousness, have dizziness, or vomiting. The patient presented with both upper and lower lid haematoma and small subconjunctival hemorrhage. Fluorescein staining was negative, anterior chamber and lens was clear. Intraocular pressure was normal. Retina and optic nerve head appeared normal on fundoscopy (Figure ). The vision was “counting fingers at 1 meter” in the right eye and 0.5 without the correction in the left eye on the Snellen chart. “Mydriacyl bottle cap or Red desat” subjective test indicated color perception dysfunction of the right eye (Figure ). Relative afferent pupillary defect (RAPD) was positive, but mild in the right eye. We immediately performed ocular ultrasound which was normal (Figure ) and orbital X ray which showed no signs of bone fracture. We decided to treat the patient immediately with the megadoses of steroids following the protocol suggested by Cerovski () (Figure ).\nThe first dose was methylprednisolone in intravenous doses of 30 mg/kg, followed 2 hours later by a dose of 15 mg/kg, and 3 additional doses after every 6 hours of 15 mg/kg of methylprednisolone i.v. Patient also received steroid eyedrops 4 times a day. The following day patients vision began to improve, BCVA (best corrected visual acuity) being 0.3 in the right eye. And the 3 rd day BCVA was 0.5. On the forth day it improved to 0.7, stenopeic 1.0. On the second day VEP (visual evoked potentials) test was performed and it showed P100 wave of lower amplitudes and latency delay in the right eye, and was normal in the left eye. CT orbital scan was also done on the second day and it did not show any pathology (Figure ). Patient came for a follow up visit after seven days and the vision was normal.