Any loss of vision after a head or face injury needs emergency care.

For patients and families

What it is

Traumatic optic neuropathy is damage to the optic nerve from an injury, such as a fall, car crash, sports injury, or assault.¹ ² The nerve can be hurt directly (for example, by a bone fragment) or indirectly, when the force of a blow is passed to the nerve.²

Signs

• Vision loss in one eye after an injury, sometimes noticed only once other injuries are treated
• Colors looking faded
• The eye itself may look normal at first

Treatment

Care depends on the type of injury. Many people are watched closely, and some recover part of their vision without specific treatment.¹ ² Steroids and surgery have not been clearly shown to help in most cases, and high-dose steroids carry risks in people with head injuries.³ ⁴ Your care team will explain the options for your situation.

For clinicians

• Assessment: document acuity, color, RAPD, and fields where possible, often in a patient with competing injuries; the disc is usually normal acutely with pallor developing over weeks.² Obtain CT of the orbits and optic canal to identify fractures, hematoma, or foreign bodies.
• Urgent surgical problems: orbital compartment syndrome from retrobulbar hemorrhage requires immediate lateral canthotomy and cantholysis; this is distinct from indirect TON.
• Evidence on treatment: the International Optic Nerve Trauma Study (non-randomized) found no clear benefit for corticosteroids or optic canal decompression compared with observation.¹ A Cochrane review found no convincing evidence that steroids improve visual outcome.³ The CRASH trial found higher mortality with high-dose methylprednisolone in significant head injury.⁴ Observation is reasonable for many patients; treatment decisions are individualized.

References

1. Levin LA, et al. The treatment of traumatic optic neuropathy: the International Optic Nerve Trauma Study. Ophthalmology. 1999;106(7):1268-1277. https://pubmed.ncbi.nlm.nih.gov/10406604/
2. EyeWiki (American Academy of Ophthalmology). Traumatic Optic Neuropathy. https://eyewiki.org/Traumatic_Optic_Neuropathy
3. Yu-Wai-Man P, Griffiths PG. Steroids for traumatic optic neuropathy. Cochrane Database Syst Rev. 2013;(6):CD006032. https://pubmed.ncbi.nlm.nih.gov/23771729/
4. Roberts I, et al. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial). Lancet. 2004;364(9442):1321-1328. https://pubmed.ncbi.nlm.nih.gov/15474134/

How to reach us

Hazleton Eye Specialists: phone 570-453-2020, fax 570-453-1020. Addresses for all five offices (Hazleton, Stroudsburg, Nanticoke, Pottsville, and Bangor) are on Find an Eye Doctor.

Sudden vision loss needs same-day care. Call an eye doctor right away. If you also have a new headache, jaw pain when chewing, scalp tenderness, fever, or you are over 50 and feel unwell, go to the emergency department.

Medical disclaimer. This page is for general education. The patient section is not medical advice, and the clinician section is not a clinical practice guideline; neither replaces an examination, clinical judgment, or specialty consultation. If you have sudden vision loss, seek same-day care from an eye doctor or an emergency department. Information is current as of the “last reviewed” date.