Traumatic Optic Nerve Injury and Vision Loss After an Accident

Q: Traumatic Optic Nerve Injury and Vision Loss After an Accident

Hello, Afang： Injuries to the brain, orbit, or eyeball can potentially damage the optic nerve, which can be categorized into direct and indirect injuries. <br>Direct traumatic optic neuropathy results from the optic nerve being directly torn by external force, or being severed by

Optic nerve injury

My wife was involved in a car accident on February 25, where she sustained a frontal impact injury to her right eye.
After receiving treatment for some time, she developed significant bruising in her left eye and was recently discharged from the hospital, requiring regular follow-up visits.
The physician diagnosed her with traumatic optic neuropathy.
Initially, her vision was relatively good, but post-injury, her visual acuity has deteriorated to 0.1 in the right eye and 0.03 in the left eye, with significant double vision.
The right pupil shows poor light response, and my wife has reported that her vision has become even more blurred in recent days; she can only see the outline of a clock on the wall that is 1.5 meters away, with the rest appearing as indistinct colors.

I would like to inquire whether the damage to the optic nerve and her vision is due to the nerve fibers being severed while the optic nerve itself remains intact.
If there is a severance, how can it be repaired? Is her increasing blurriness related to further damage to the optic nerve fibers? Is the double vision a result of the injury to the optic nerve fibers? Upon discharge, the physician mentioned that high doses of B vitamins could gradually improve her condition.
What does "gradually" mean in this context? It seems to imply that we should indefinitely continue taking B vitamins and other supplements.
Are there any more proactive treatment options available?
Sincerely concerned husband.

Afang, 50~59 year old female. Ask Date: 2021/03/11

Dr. Gao Pilin reply Ophthalmology

Hello, Afang: Injuries to the brain, orbit, or eyeball can potentially damage the optic nerve, which can be categorized into direct and indirect injuries.
Direct traumatic optic neuropathy results from the optic nerve being directly torn by external force, or being severed by bone fragments or other foreign objects.
Hemorrhage within the orbit or the nerve sheath can further lead to compressive optic neuropathy.
Indirect traumatic optic neuropathy is more common than direct injury, typically caused by shear forces from head trauma that transmit to the optic nerve and its blood vessels within the optic canal, resulting in ischemic damage to the optic nerve.
Currently, there are no aggressive treatments available, although some individuals may recover partial vision.
For more information, you can refer to the following links: https://bit.ly/3liuGvT https://bit.ly/2ONKKtm.
Ophthalmology at Puzi Hospital in Taiwan: Monday, Tuesday, Thursday, and Friday mornings from 8:00 AM to 12:00 PM, Wednesday afternoons from 2:00 PM to 4:30 PM.
Online responses are for reference only; it is necessary to seek medical attention at a healthcare facility if needed.
I hope to have the opportunity to serve you.
Gao Pilin

Reply Date: 2021/03/11

More Info

I'm sorry to hear about your wife's traumatic experience and the challenges she is facing with her vision. Traumatic optic nerve injury can be a complex condition, and understanding its implications is crucial for both you and your wife as you navigate her recovery.

Firstly, the optic nerve is responsible for transmitting visual information from the retina to the brain. When an injury occurs, such as in your wife's case from a car accident, it can lead to various degrees of damage. This damage can manifest as a partial or complete disruption of the nerve fibers. In many cases, the optic nerve may not be completely severed, which means that some nerve fibers are still intact, but they may be damaged or dysfunctional. This could explain why your wife has experienced significant vision loss and symptoms like double vision (diplopia) and poor pupillary response.

The worsening of her vision could be attributed to several factors, including swelling, inflammation, or further damage to the optic nerve or surrounding structures. It's essential to monitor these symptoms closely, as they can indicate changes in her condition. The presence of double vision is often related to miscommunication between the eyes due to the injury affecting the muscles or nerves that control eye movement. This could be a direct result of the optic nerve injury or related to other ocular or neurological issues stemming from the trauma.

Regarding the treatment options, unfortunately, there is currently no definitive surgical intervention that can repair a damaged optic nerve. However, some studies suggest that high-dose corticosteroids may help reduce inflammation and improve outcomes if administered shortly after the injury. The use of B vitamins, particularly B1 (thiamine), B6 (pyridoxine), and B12 (cobalamin), is often recommended to support nerve health and potentially aid in recovery. The term "slowly improve" typically refers to the gradual process of nerve healing, which can take weeks to months, and varies significantly from person to person.

It's understandable to feel overwhelmed by the prospect of long-term supplementation with B vitamins and other nutrients. While these can be beneficial, they should be part of a broader treatment plan that includes regular follow-ups with her ophthalmologist or a neurologist specializing in optic nerve injuries. They may recommend additional therapies, such as vision rehabilitation, which can help maximize any remaining vision and improve quality of life.

In addition to nutritional support, other interventions may include:
1. Vision Therapy: This can help retrain the brain to process visual information more effectively, especially if there are issues with eye coordination or perception.

2. Low Vision Aids: Devices such as magnifiers or specialized glasses can assist in making the most of her remaining vision.

3. Psychological Support: Coping with vision loss can be emotionally challenging. Counseling or support groups can provide valuable resources and emotional support.

4. Regular Monitoring: Continuous follow-up with healthcare providers is essential to assess her condition and adjust treatment as necessary.

In conclusion, while the path to recovery from traumatic optic nerve injury can be uncertain and lengthy, there are supportive measures and therapies available that can help. It's crucial to maintain open communication with her healthcare team and advocate for a comprehensive approach to her recovery. Your concern and involvement in her care will be vital as she navigates this challenging time.

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