A case of traumatic optic neuropathy induced by a zygomatic bone fracture

• Published in: Japanese Journal of Oral and Maxillofacial Surgery Vol. 57; no. 2; pp. 70 - 73
• Main Authors: OKUBO, Takuma, FUJIWARA, Shigeyoshi, SATO, Haruki, HASHIMOTO, Kengo, NAGANAWA, Ryosuke, OH-IWA, Ichiro
• Format: Journal Article
• Language: Japanese; English
• Published: Japanese Society of Oral and Maxillofacial Surgeons 20.02.2011
• Subjects: ocular pressure; optic acuity; orbital fracture; traumatic optic neuropathy; zygomatic bone fracture
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.57.70

Traumatic optic neuropathy （TON） involves various grades of vision loss or deterioration without ocular injury following facial trauma. Causes of TON include direct optic nerve injury, fractured bone fragments, optic nerve ischemia, and optic nerve compression by hematoma or edema. We treated a 78-year-old woman with impaired left visual acuity caused by optic nerve compression by the fragments of a left zygomatic bone fracture.After detailed optic examinations by an ophthalmologist and neurosurgeon in the departments of ophthalmology and neurosurgery, open reduction and fixation were performed about 27 hours after injury. The patient gradually recoved from TON and had no severe complications after the operation. Although the management of TON remains controversial, many reports suggest that there is no significant difference in outcomes between surgical treatment and non-surgical treatment. However, zygomatic bone fracture with clinically significant dislocation or nerve impairment is generally an indication for surgical reduction. Since few reports have documented exacerbation of visual acuity after open reduction and fixation, operation should not be delayed in patients with no systemic problems. Consideration of optic functions and consultation with related departments are essential when treating patients with mid-facial fractures.